TITLE

2010 - Physical examination and classification of murmur findings into patterns improved diagnosis of systolic murmurs in adult inpatients

AUTHOR(S)
Merugu, Srinivas
PUB. DATE
March 2011
SOURCE
ACP Journal Club;3/20/2011, Vol. 154 Issue 3, p11
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Question What is the value of physical examination, particularly sorting murmurs into topographic patterns, for diagnosis of pathologic murmurs in adult inpatients? Methods Design Mostly blinded comparison of physical examination with transthoracic echocardiography (echo). A blinded cardiologist interpreted all echos. Except for 14 patients, the author conducting the physical examination did not have clinical knowledge of the patients or their echo results. Setting Seattle Veterans Affairs Medical Center, Washington, USA. Patients A convenience sample of 376 inpatients (mean age 69 y, 98% men based on 409 patients examined) who had echos. 7% of echos were ordered to diagnose unexplained murmurs, 59% to assess structural heart disease, and 16% to follow up on known valvular disease. Patients with diastolic murmurs were excluded. Description of test With the patient in supine position, the investigator assessed vital signs; arterial, venous, and precordial pulsations; and auscultated the anterior chest from apex to clavicles for heart sounds and murmurs. Findings of systolic murmurs were characterized using onomatopoeia (naming by vocal imitation of the sound), intensity, and sorting into 6 predetermined topographic patterns (see Figure 1, page 916 of the original article, for details on patterns). Diagnostic standard Transthoracic echo. Outcomes Likelihood ratios. Main results The prevalences of any systolic murmur, aortic stenosis (AS) (peak aortic velocity >2.5 m/s on echo), mitral regurgitation (MR), and tricuspid regurgitation (TR) were 59%, 19%, 20%, and 17%, respectively. The broad apical-base murmur pattern detected AS, the left lower sternal murmur pattern detected TR, and the broad apical murmur pattern detected MR (Table). Absence of a murmur tended to rule out only AS (Table). Murmur radiation, heart sounds, and carotid upstroke also aided diagnosis (Table). Conclusion Classification of murmur auscultation into precordial patterns and select additional physical examination findings were useful for diagnosing systolic murmurs in adult inpatients.
ACCESSION #
78325716

 

Related Articles

  • Physical examination and classification of murmur findings into patterns improved diagnosis of systolic murmurs in adult inpatients. Merugu, Srinivas // ACP Journal Club;3/20/2011, Vol. 154 Issue 3, p11 

    The article discusses a study which observed the value of physical examination, particularly sorting murmurs into topographic patterns, for diagnosis of pathologic murmurs in adult inpatients. The study was conducted by researcher S. McGee and was published in a 2010 issue of the "American...

  • So-called Innocent Systolic Murmurs.  // British Medical Journal;2/1/1975, Vol. 1 Issue 5952, p229 

    Examines the incidence of systolic murmurs. Description of systolic mitral murmur; Causes for systolic murmurs; Comparison of systolic murmur diagnosis with cardiomyopathy.

  • Ãœfürümlü çocuÄŸa yaklaşım. Eroğlu, Ayşe Güler // Turkish Pediatrics Archive / Turk Pediatri Arsivi;jun2009, Vol. 44 Issue 2, p48 

    Heart murmur is a common finding in children. Fortunately, most of these murmurs are innocent murmurs. Innocent murmurs can be detected in 70-85% of healthy children. In contrast, the incidence of congenital heart disease is 0.8% and acquired heart disease is rare in children. Therefore,...

  • Murmurs, fainting, chest pain: Time for a cardiology referral? Brumund, Michael R.; Strong, William B. // Contemporary Pediatrics;Mar2002, Vol. 19 Issue 3, p155 

    Reviews findings in the history and physical examination of children with murmurs, chest pain and syncope that suggest an underlying cardiac abnormality. Association between murmurs and structural heart disease; Characteristics of a murmur; Most common causes of pathologic heart murmurs.

  • More techniques of auscultation: General principles of murmurs. Marshall, Kenneth G. // Patient Care;2/1/1997, Vol. 31 Issue 2, pS1 

    Provides information pertaining to the diagnosis of systolic and diastolic murmurs. How to determine whether a murmur s systolic or diastolic; What is the most important feature of a systolic murmur; Identification of the important causes of systolic ejection murmurs.

  • Benign pediatric heart murmurs.  // American Family Physician;1/1/1996, Vol. 53 Issue 1, p388 

    Reports that less than one percent of children with heart murmurs have congenital heart disease. Diagnosis of heart murmurs; Important historical information; Physical examination; Most common benign murmurs.

  • Phono-spectrographic analysis of heart murmur in children. Anna-Leena Noponen; Sakari Lukkarinen; Anna Angerla; Raimo Sepponen // BMC Pediatrics;2007, Vol. 7, p23 

    Background: More than 90% of heart murmurs in children are innocent. Frequently the skills of the first examiner are not adequate to differentiate between innocent and pathological murmurs. Our goal was to evaluate the value of a simple and low-cost phonocardiographic recording and analysis...

  • Evaluation and Management of Heart Murmurs in Children. FRANK, JENNIFER E.; JACOBE, KATHRYN M. // American Family Physician;10/1/2011, Vol. 84 Issue 7, p793 

    Heart murmurs are common in healthy infants, children, and adolescents. Although most are not pathologic, a murmur may be the sole manifestation of serious heart disease. Historical elements that suggest pathology include family history of sudden cardiac death or congenital heart disease, in...

  • Acquired supravalvar type of left ventricular to right atrial communication following non-penetrating cardiac trauma caused by traffic accident. Sasaki, N.; Shimoyama, M. // Heart;Mar2003, Vol. 89 Issue 3, p341 

    Reports on examination of a 48-year-old woman for strong systolic heart murmur. Start of the murmur after involvement of the woman in a traffic accident; Findings of the transesophageal echocardiogram.

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics