A systolic crescendo-decrescendo murmur heard best at the right second intercostal space that radiates to the carotids indicates which valvular lesion?

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

Answer: (B)

A systolic crescendo-decrescendo murmur heard best at the right second intercostal space that radiates to the carotids is the classic sign of aortic stenosis. The right upper sternal border marks the aortic area, and the blood is being forcefully ejected through a narrowed aortic valve during systole, creating a harsh, diamond-shaped murmur that crescendos as flow rate increases and then decrescends as flow falls. The high-velocity jet travels along the aorta and can be felt or heard in the carotid arteries, producing the characteristic radiation.

Think of the other lesions this way: aortic regurgitation is a diastolic murmur best heard along the left sternal border with a wide pulse pressure, not a systolic murmur at the right upper chest. Mitral stenosis is a diastolic murmur best at the apex, often with an opening snap, and does not present as a systolic signal in the aortic area. Pulmonary stenosis is a systolic murmur heard best at the left upper sternal border and doesn’t typically radiate to the carotids.

So the description points to aortic stenosis.