A 35 year old athlete has height 184 cm., arm span 194cm., pulse rate 64/min., BP148/64 mm Hg. Chest ausultation reveals long diastolic murmur over right 2nd intercostal space on routine examination. The probable diagnosis is -
High-Yield Explanation
The patient has Marfan's syndrome. In chronic severe AR, the jarring of the entire body and the bobbing motion of the head with each systole can be appreciated, and the abrupt distention and collapse of the larger aeries are easily visible. The examination should be directed toward the detection of conditions predisposing to AR, such as bicuspid valve, endocarditis, Marfan's syndrome, and ankylosing spondylitis. The murmur of chronic AR is typically a high-pitched, blowing, decrescendo diastolic murmur, heard best in the third intercostal space along the left sternal border. ( Harrison's principle of internal medicine,18th edition,pg no. 1944)