Advanced Physical Diagnosis
Examination
  • Techniques
• 1st & 2nd Heart Sounds
• 2nd & 3rd Heart Sounds
• Clicks and Snaps
• Murmurs
• Rubs
  • Demonstrations
Historical
Pathophysiology
Associated Evaluations
  • Patient HX
  • Physical Exam
  • Laboratory & Imaging
Differential Dx
Evidence Base
• Accuracy in Diagnosis of Systolic Murmurs
• Accuracy in Diagnosis of Diastolic Murmurs
• Accuracy in Diagnosis of CHF
References
Teaching Tips
[Skill Modules >> Heart Sounds & Murmurs >> Evidence Base ]

Evidence Base: Heart Sounds & Murmurs

Accuracy in Diagnosis of Systolic Murmurs

Maneuvers

This study looks at the sensitivity, specificity and predictive value of physical exam maneuvers that historically have been used in diagnosing systolic murmurs.

Two cardiologist independently examined 50 patients age 6 to 85 years of age ( mean age 45) with a systolic murmur I / VI or greater. The cardiologists were separated from the patients by a partition. An independent examiner instructed the patients in the maneuvers and supervised the implementation of them.

Maneuvers--result in increased murmur Murmur Sens(%) Spec(%) LR+ LR-
Inspiration Right-sided 100 88 8.3 0
Valsalva HCM 65 96 16.25 0.36
Squat to stand HCM 95 84 5.9 0.06
Handgrip Mitral regurgitation, VSD 68 92 8.5 0.35
Transient arterial occlusion Mitral regurgitation, VSD 78 100   -
Maneuvers--result in decreased murmur Murmur Sens(%) Spec(%) LR+ LR-
stand to squat HCM 95 84 5.9 0.06
Leg elevation HCM 85 91 10.63 0.16
Handgrip HCM 85 75 3.4 0.2

HCM = hypertrophic cardiomyopathy
VSD = ventricular septal defect

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