Initial clinical evaluation of cardiac systolic murmurs in the ED by noncardiologists

It is not exactly known how ED physicians perform in evaluating cardiac systolic murmurs. In 203 consecutive medical ED patients with systolic murmur, we compared the initial clinical evaluation, including auscultation, with transthoracic echocardiography. Of the 203 patients, 132 (65%) had innocent...

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Bibliographic Details
Published in:The American journal of emergency medicine 2004-03, Vol.22 (2), p.71-75
Main Authors: Reichlin, Serge, Dieterle, Thomas, Camli, Can, Leimenstoll, Bernd, Schoenenberger, Ronald A, Martina, Benedict
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cardiovascular disease
Cardiovascular diseases
clinical medicine
Diagnosis, Differential
Emergency medical care
Emergency Service, Hospital
Female
Heart Auscultation
heart murmurs
Heart Murmurs - diagnostic imaging
Heart Murmurs - physiopathology
Heart Valve Diseases - diagnostic imaging
Heart Valve Diseases - physiopathology
Humans
Intensive care medicine
Internal medicine
Male
Medical sciences
Medicine
Middle Aged
Multivariate analysis
Older people
physical examination
Physicians
Prospective Studies
Sensitivity and Specificity
Standard deviation
Studies
Systole
Systole - physiology
Thoracic surgery
Ultrasonography
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Summary:It is not exactly known how ED physicians perform in evaluating cardiac systolic murmurs. In 203 consecutive medical ED patients with systolic murmur, we compared the initial clinical evaluation, including auscultation, with transthoracic echocardiography. Of the 203 patients, 132 (65%) had innocent murmurs and 71 patients (35%) had valvular heart disease. Sensitivity and specificity of the initial clinical routine evaluation in diagnosing echocardiographic valvular heart disease were 82% (70%–86%) and 69% (60%–76%), respectively. Independent significant positive predictors of valvular heart disease were grade >2/6 systolic murmur (odds ratio [OR], 8.3; confidence interval [CI], 3.5–19.7, P
ISSN:0735-6757
1532-8171
DOI:10.1016/S0735-6757(03)00093-7