If a bounding carotid pulse is found on a 62-year-old patient, which murmur should be investigated?

A bounding carotid pulse is typically associated with conditions that result in increased stroke volume and decreased vascular resistance, which can often indicate a state of hyperdynamic circulation. In this context, aortic insufficiency is particularly relevant.

In aortic insufficiency, the regurgitation of blood from the aorta back into the left ventricle during diastole leads to an increase in left ventricular volume. As the heart compensates for this increased volume, it increases stroke volume, resulting in a bounding pulse. This physiological response resembles the characteristic pulse description known as "water-hammer pulse."

While the other murmurs listed, such as aortic stenosis, mitral regurgitation, and pulmonic stenosis, can lead to various types of pulses, they do not specifically correlate with the findings of a bounding pulse in the same manner that aortic insufficiency does. Aortic stenosis typically presents with a weak, delayed pulse due to reduced stroke volume. Mitral regurgitation can cause a more variable pulse quality depending on the severity and hemodynamic status of the patient, while pulmonic stenosis generally leads to diminished pulses.

Thus, the presence of a bounding carotid pulse strongly suggests aortic insufficiency as a notable condition