Laboratory and Imaging - Heart Sounds & Murmurs Exam - Physical Diagnosis Skills - University of Washington School of Medicine

Given the imperfect physical examination in diagnosing fluid overload and decreased left ventricular function, other studies are often helpful. These include radiography and echocardiography.

Radiography

Normal chest x-ray with normal pulmonary veins
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Chest x-ray with pulmonary edema
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*Unless otherwise noted, all images are from the Cardiovascular Resources Videodisc.

Echocardiography

Guidelines for Diagnostic Testing
(American College of Cardiology / American Heart Association (AHA))

Echocardiography Guidelines

Murmurs in ASYMPTOMATIC Individuals

Echocardiography Recommendation	Murmur Heard
Strong evidence or opinion in favor of Echo(I)	Diastolic or continuous murmurs
	Holosystolic or late systolic murmurs
	Grade 3 or greater midsystolic murmurs
Conflicting evidence or opinion but generally favoring (IIa)	Murmurs associated with abnormal physical examination findings on cardiac exam
	Murmurs associated with abnormal EKG or chest x-ray
Evidence or opinion that not useful or may be harmful	Grade 2 or softer midsystolic murmur identified as innocent

Murmurs in SYMPTOMATIC Individuals

Echocardiography Recommendation	Murmur Heard
Strong evidence or opinion in favor of echo(I)	Symptoms or signs of CHF, MI or syncope
Strong evidence or opinion in favor of echo(I)	Symptoms or signs consistent with infective endocarditis or thromboembolism
Conflicting evidence or opinion but generally favoring (IIa)	Symptoms or signs most likely noncardiac but cardiac disease not excluded by standard evaluation.
Evidence or opinion that not useful or may be harmful	Symptoms or signs most likely non cardiac with an isolated midsystolic"innocent" murmur.

Class I	Conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful or effective
Class II	Conditions for which there is conflicting evidence and/or divergence of opinion about the usefulness/efficacy of a procedure or treatment agreement that a given procedure or treatment is useful or effective
Class IIa	Weight of evidence/opinion is in factor of usefulness/efficacy
Class IIb	Usefulness/efficacy is less well established by evidence/opinion
Class III	Conditions for which there is evidence and/or general agreement that a given procedure is not useful and in some cases may be harmful