May 28, 1997

The Rational Clinical Examination: Detecting Abnormal Systolic Murmurs

Author Affiliations

Hospital of the University of Pennsylvania Philadelphia

JAMA. 1997;277(20):1593-1594. doi:10.1001/jama.1997.03540440027022

To the Editor.  —Dr Etchells and colleagues1 have published a thorough review of studies assessing the available evidence of the precision and accuracy of the clinical examination for abnormal systolic murmurs. Their conclusions, however, beg the question posed in their title: "Does this patient have an abnormal systolic murmur?" As the authors point out, "clinicians are primarily concerned whether a systolic murmur indicates a cardiac abnormality," ie, which patients need further evaluation (such as echocardiography) or therapeutic intervention (such as antibiotic prophylaxis with procedures). Two studies not included in the MEDLINE search by the authors address this issue.Roldan et al2 studied the value of the cardiovascular physical examination for detecting valvular heart disease in asymptomatic subjects. They found that, of 143 subjects younger than 61 years (68 apparently healthy and 75 with no cardiac symptoms but with connective tissue diseases), a single cardiologist's determination of a murmur