Early diastolic murmurs in end-stage renal failure.

Alexander, Weymann; Polak, Amanda

doi:10.1136/hrt.39.8.900

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…The clinical context of a diastolic murmur is important, as patients with end stage renal failure and volume overload may have transient early diastolic murmurs that resolve with correction of volume overload. 146 The physical examination is of limited value in assessing the severity of aortic regurgitation. However, severe aortic regurgitation is unlikely with very quiet (grade 1) murmurs (LR+ 0, 0 to 0.9) and more likely when either a third heart sound (LR+ 5.9, 1.4 to 25) or grade 3 murmur (LR+ 4.5, 1.6 to 14) is present.…”

Section: Tricuspid Regurgitationmentioning

confidence: 99%

How valuable is physical examination of the cardiovascular system?

Elder¹,

Japp²,

Verghese

2016

BMJ

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Physical examination of the cardiovascular system is central to contemporary teaching and practice in clinical medicine. Evidence about its value focuses on its diagnostic accuracy and varies widely in methodological quality and statistical power. This makes collation, analysis, and understanding of results difficult and limits their application to daily clinical practice. Specific factors affecting interpretation and clinical application include poor standardisation of observers' technique and training, the study of single signs rather than multiple signs or signs in combination with symptoms, and the tendency to compare physical examination directly with technological aids to diagnosis rather than explore diagnostic strategies that combine both. Other potential aspects of the value of physical examination, such as cost effectiveness or patients' perceptions, are poorly studied. This review summarises the evidence for the clinical value of physical examination of the cardiovascular system. The best was judged to relate to the detection and evaluation of valvular heart disease, the diagnosis and treatment of heart failure, the jugular venous pulse in the assessment of central venous pressure, and the detection of atrial fibrillation, peripheral arterial disease, impaired perfusion, and aortic and carotid disease. Although technological aids to diagnosis are likely to become even more widely available at the point of care, the evidence suggests that further research into the value of physical examination of the cardiovascular system is needed, particularly in low resource settings and as a potential means of limiting inappropriate overuse of technological aids to diagnosis.

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Section: Tricuspid Regurgitationmentioning

confidence: 99%

How valuable is physical examination of the cardiovascular system?

Elder¹,

Japp²,

Verghese

2016

BMJ

View full text Add to dashboard Cite

show abstract

“…When a cardiologist hears the murmur of PR, the likelihood of PR increases (positive LR, 17 in both studies), but absence of a PR murmur was not helpful for ruling out PR (LR, 0.9 in both studies). 37,43 51 These murmurs typically disappear after the treatment of volume overload, as was demonstrated in 2 small studies (grade C). 51,52 These murmurs are probably due to transient pulmonary hypertension and dilation of the pulmonary artery root, leading to PR.…”

Section: Mitral Stenosis and Prmentioning

confidence: 67%

“…37,43 51 These murmurs typically disappear after the treatment of volume overload, as was demonstrated in 2 small studies (grade C). 51,52 These murmurs are probably due to transient pulmonary hypertension and dilation of the pulmonary artery root, leading to PR. 52…”

Section: Mitral Stenosis and Prmentioning

confidence: 67%