Heart Sounds, Murmurs, and Valvular Heart Disease

Abstract

Nowhere in medicine is the physician better able to make a giant leap of understanding in the etiologic mechanisms of human disease than at the bedside listening to the heart with a few simple questions in mind. Lembo et al. have demonstrated sensitivities and specificities as high as 80% to 100% with high predictivity for the bedside diagnosis of systolic murmurs.¹Thus even with important high technology tests, a careful history and physical examination remain the most useful procedures. Maneuvers such as standing, squatting, Valsalva maneuver, deep breathing, hand grip, amyl nitrate, changing of body positions from recumbent to sitting to leaning forward, and left lateral recumbency are required to reach the sensitivities and specificities described by Lembo. These maneuvers are easily learned, require only a few minutes to perform, and greatly increase the worth of the examination.