A harsh, blowing, pansystolic murmur heard at the apex indicates which valvular disease?

• A. Aortic stenosis
• B. Tricuspid regurgitation
• C. Pulmonary stenosis
• D. Mitral regurgitation

Answer: (D)

A holosystolic, harsh, blowing murmur heard best at the apex points to mitral regurgitation. In this condition, the mitral valve fails to close fully during systole, so blood leaks backward from the left ventricle into the left atrium throughout systole. That continuous backward flow creates a pansystolic murmur that is characteristically heard best at the apex and often radiates toward the axilla. The blowing quality reflects a regurgitant jet rather than a forward-flow stenotic process.

Other murmurs don’t fit as neatly: aortic stenosis is a systolic ejection murmur heard best at the right upper sternal border with radiation to the carotids; tricuspid regurgitation is holosystolic heard at the left lower sternal border and is influenced by inspiration; pulmonary stenosis is a systolic murmur best heard at the left upper sternal border and does not localize to the apex.