A murmur is heard at the second left intercostal space along the left sternal border. Which valve is this?
A. Aortic
B. Mitral
C. Pulmonic
D. Tricuspid
Correct Answer: C. Pulmonic
Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. The murmur has a crescendo–decrescendo configuration. There is a strong tendency for the murmur to peak later in systole as stenosis becomes more severe. The murmur is best heard over the second intercostal space at the left sternal border and does not radiate.
Option A: Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum. The murmur is commonly described as harsh, rasping, grunting, or rough. Best heard over the primary and secondary aortic area, the murmur is transmitted widely over the precordium and radiates to the carotid arteries.
Option B: Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line. The murmur of acute mitral regurgitation is typically decrescendo and of variable intensity (usually grade 3 or higher). It begins with the first heart sound and decreases in intensity throughout systole, occasionally terminating before the aortic component of the second heart sound.
Option D: Tricuspid valve abnormalities are heard at the 3rd and 4th intercostal spaces along the sternal border. The murmur of acute tricuspid valve regurgitation (due to infective endocarditis or trauma) is similar in character to that previously described, but often possesses a decrescendo configuration (similar to acute mitral regurgitation) and may terminate before the second heart sound.
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