MEDizzy - Physical examination of a 41-year-old narcotic abusor

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Cardiovascular Physiology

Physical examination of a 41-year-old narcotic abusor reveals an early systolic murmur. The physician also notes a 7-cm distance between the height of the blood in his right internal jugular vein and sternal angle (normal = 3 cm). Which of the following conditions is most likely responsible for the physical findings?

ExplanationEarly systolic murmurs begin with the first heart sound and end in midsystole. The higher-than-normal height of the jugular blood column reflects an increased right atrial pressure. The combination of an early systolic murmur and high right atrial pressure is indicative of tricuspid regurgitation. This lesion is common in narcotic abusers with infective endocarditis. Mitral stenosis and aortic regurgitation produce diastolic murmurs.