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JAMA Diagnostic Test Interpretation
March 10, 2015

Doppler Echocardiography in the Evaluation of a Heart Murmur

Author Affiliations
  • 1Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
  • 2Division of Cardiology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Brazil
  • 3Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
JAMA. 2015;313(10):1050-1051. doi:10.1001/jama.2015.1278

A 91-year-old woman with a history of hypertension, hypercholesterolemia, and stage 3 renal insufficiency presented for a routine office visit. She reported no chest pain, dyspnea on exertion, presyncope, orthopnea, paroxysmal nocturnal dyspnea, or pedal edema.

Physical examination demonstrated blood pressure of 140/76 mm Hg and a heart rate of 72/min. Carotid upstrokes were slightly delayed with a transmitted murmur. Lungs were clear bilaterally. Cardiac examination demonstrated a regular rate and rhythm, normal S1, 3/6 harsh, late-peaking systolic murmur that radiated to the carotids with soft A2, 2/4 diastolic decrescendo murmur at the left lower sternal border, and 2/6 holosystolic murmur at the apex. Distal pulses were 2+ bilaterally. There was no edema.

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