Does this patient have an abnormal systolic murmur?

Area of Science:

• Cardiology
• Diagnostic Accuracy
• Clinical Examination

Background:

• Abnormal systolic murmurs are common clinical findings.
• Accurate diagnosis relies on precise clinical examination.
• Evidence on the diagnostic precision of clinical examination needs review.

Purpose of the Study:

• To review evidence on the precision and accuracy of clinical examination for abnormal systolic murmurs.
• To identify key clinical findings for diagnosing specific cardiac conditions.
• To assess the reliability of the clinical examination in cardiology.

Main Methods:

• Conducted a MEDLINE search and reviewed reference lists.
• Contacted authors for additional published studies.
• Independent review and quality grading by two observers for each study.

Main Results:

• Reliability of detecting systolic murmurs was fair (kappa, 0.30-0.48).
• Specific findings aid in ruling in aortic stenosis (e.g., slow carotid pulse rise, murmur intensity, S2 intensity).
• Absence of murmur radiation to the right carotid artery is useful for ruling out aortic stenosis.

Conclusions:

• Clinical examination by cardiologists is accurate for detecting various causes of abnormal systolic murmurs.
• Smaller studies suggest accuracy for mitral regurgitation, tricuspid regurgitation, hypertrophic cardiomyopathy, and mitral valve prolapse.
• Studies evaluating non-cardiologist examiners are necessary to broaden applicability.