Rationale
Murmurs and abnormal heart sounds may be detected on physical examination. Although systolic murmurs are often “innocent” or physiologic, diastolic murmurs are virtually always pathologic. A thorough history and physical examination almost always identify which patient cases require further investigation and management.
Causal Conditions
(list not exhaustive)
- Abnormal heart sounds
- S1 (e.g., mitral stenosis, atrial fibrillation)
- S2 (e.g., hypertension, aortic stenosis)
- S3 (e.g., heart failure)
- S4 (e.g., hypertension)
- Abnormal splitting (e.g., atrial septal defect)
- Systolic murmurs
- Ejection murmurs (e.g., physiologic, aortic stenosis)
- Pansystolic murmurs (e.g., mitral regurgitation)
- Diastolic murmurs
- Early (e.g., aortic regurgitation)
- Mid-diastolic (e.g., mitral stenosis)
- Pericardial friction rubs
Key Objectives
Given a patient with a murmur or abnormal heart sounds, the candidate will differentiate innocent from pathologic conditions; diagnose the cause, severity, and complications; and initiate an appropriate management plan.
Enabling Objectives
Given a patient with a murmur or abnormal heart sounds, the candidate will
- list and interpret critical clinical findings, including
- the origin of the abnormal sound and/or murmur; and
- results of an appropriate history and physical examination aimed at determining the underlying pathological condition, including severity and complications (e.g., heart failure, endocarditis);
- list and interpret critical investigations, including
- diagnostic screening for cardiac arrhythmia by means of clinical findings and electrocardiogram; and
- appropriate diagnostic imaging, including echocardiography, for further investigation of the murmur or abnormal heart sounds; and
- construct an effective initial management plan, including
- initiating management for the underlying condition and its complications (e.g., heart failure, atrial fibrillation, endocarditis);
- recommending endocarditis prophylaxis if indicated; and
- determining whether the patient requires specialized care.