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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Murmur, Diastolic
Niteesh K. Choudhry, Edward E. Etchells
Duroziez double intermittent femoral bruit is elicited by first gently compressing the femoral...


Topics Discussed: aortic valve insufficiency, austin flint murmur, diagnostic process, diastolic murmur, first heart sound, s1, heart auscultation, heart sounds, mitral valve stenosis, pulmonary valve insufficiency, pulse pressure

Excerpt: "Aortic regurgitation is a potentially serious cardiac abnormality that may be caused by important underlying disorders. Patients with AR require careful clinical monitoring to identify the optimal time for surgical intervention. Asymptomatic patients with severe AR may benefit from vasodilator therapy.1The cardinal manifestation of AR is a diastolic murmur. Diastolic murmurs are important indicators of structural cardiac abnormalities or pathologic states of increased flow (Table 32-1). As discussed in a previous article in this series,3 heart murmurs are produced when turbulent blood flow causes prolonged auditory vibrations of cardiac structures. The intensity of the murmur depends on many factors, including blood viscosity, blood flow velocity and turbulence, the distance between the vibrations and the stethoscope, the angle at which the vibrations meet the stethoscope, the transmission qualities of the tissue between the vibration and the stethoscope, and the auditory skills of the examiner.4..."
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