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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Murmur, Diastolic
Niteesh K. Choudhry, Edward E. Etchells

Sections:  Clinical Scenario, Why Is the Clinical Examination Important in Evaluating for Aortic Regurgitation?, Methods, The Bottom Line for Aortic Regurgitation, The Bottom Line for Diastolic Murmurs in Patients With Renal Failure, Clinical Scenario—Resolution, References

Topics Discussed: aortic valve insufficiency, diastolic murmur

Excerpt: "You are asked to see a 59-year-old woman with liver cirrhosis and esophageal varices. When she was checked into the clinic, she had a pulse pressure of 70 mm Hg. Because of the wide pulse pressure, you wonder if she has aortic regurgitation (AR). You conduct a complete physical examination and hear no early-diastolic murmur in the third or fourth intercostal spaces at the left sternal border. You suspect that the wide pulse pressure is a peripheral hemodynamic consequence of cirrhosis, not AR. Do you need an echocardiogram to confirm your clinical impression that she does not have AR?..."
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