Mixed Aortic Valve Disease

 

This is quite difficult and is essentially a mixture of aortic stenosis and aortic regurgitation. I don't have a script for this. 

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If you happen to detect it confidently (kudos), then you would get extra marks for commenting on what the dominant lesion is. There is no strict rule for this, and in theory will essentially be a combination of:

• Pulse volume
• Apex beat
• Murmur
• Systolic blood pressure
• Pulse pressure

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Most of these are pretty subjective, and hard to put much weight on (e.g. the pulse volume/character...). If you get a case like this, I would put most emphasis on the pulse pressure (e.g. if there is a very wide pulse pressure, I would be inclined to describe the AR as the dominant lesion) 

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