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It is possible to tell whether a heart murmur is caused by an underlying abnormality without doing an echocardiogram. A heart murmur occurs when unusual blood flow within the heart causes an abnormal sound. It can be caused by an anatomic abnormality. Researchers reviewed the literature to find studies on the accuracy of the physical exam in detecting cardiac abnormalities underlying murmurs. Most of the studies confirmed the adequacy of the physical exam. However, most of the studies evaluated cardiologists., Our objective was to review the available evidence of the precision and accuracy of the clinical examination for abnormal systolic murmurs. We conducted a MEDLINE search,, manually reviewed all reference lists, and contacted authors of published studies. Each study was independently reviewed by 2 observers and graded for methodologic quality. We found that most studies were conducted using cardiologist examiners. In the clinical setting, the reliability of detecting systolic murmurs was fair (k, 0.30-0.48). The most useful findings for ruling in aortic stenosis are a slow rate of rise of the carotid pulse (positive likelihood ratio, 2.8-130), mid to late peak intensity of the murmur (positive likelihood ratio, 8.0-101), and decreased intensity of the second heart sound (positive likelihood ratio, 3.1-50). The most useful finding for ruling out aortic stenosis is the absence of murmur radiation to the right carotid artery (negative likelihood ratio, 0.05-0.10). Smaller, lower-quality studies indicate that cardiologists can accurately rule in and rule out mitral regurgitation, tricuspid regurgitation, hypertrophic cardiomyopathy, and echocardiographic mitral valve prolapse. We conclude that the clinical examination by cardiologists is accurate for detecting various causes of abnormal systolic murmurs. Studies of the clinical examination by noncardiologists are needed. JAMA. 1997;277:564-571

The article discusses the benefits of single-patient rooms for patients in hospitals. The positive and negative aspects of providing patients with single-occupancy rooms are highlighted.

Importance: Syncope can result from a reduction in cardiac output from serious cardiac conditions, such as arrhythmias or structural heart disease (cardiac syncope), or other causes, such as vasovagal syncope or orthostatic hypotension.Objective: To perform a systematic review of studies of the accuracy of the clinical examination for identifying patients with cardiac syncope.Study Selection: Studies of adults presenting to primary care, emergency departments, or referred to specialty clinics.Data Extraction and Synthesis: Relevant data were abstracted from articles in databases through April 9, 2019, and methodologic quality was assessed. Included studies had an independent comparison to a reference standard.Main Outcomes and Measures: Sensitivity, specificity, and likelihood ratios (LRs).Results: Eleven studies of cardiac syncope (N = 4317) were included. Age at first syncope of at least 35 years was associated with greater likelihood of cardiac syncope (n = 323; sensitivity, 91% [95% CI, 85%-97%]; specificity, 72% [95% CI, 66%-78%]; LR, 3.3 [95% CI, 2.6-4.1]), while age younger than 35 years was associated with a lower likelihood (LR, 0.13 [95% CI, 0.06-0.25]). A history of atrial fibrillation or flutter (n = 323; sensitivity, 13% [95% CI, 6%-20%]; specificity, 98% [95% CI, 96%-100%]; LR, 7.3 [95% CI, 2.4-22]), or known severe structural heart disease (n = 222; range of sensitivity, 35%-51%, range of specificity, 84%-93%; range of LR, 3.3-4.8; 2 studies) were associated with greater likelihood of cardiac syncope. Symptoms prior to syncope that were associated with lower likelihood of cardiac syncope were mood change or prodromal preoccupation with details (n = 323; sensitivity, 2% [95% CI, 0%-5%]; specificity, 76% [95% CI, 71%-81%]; LR, 0.09 [95% CI, 0.02-0.38]), feeling cold (n = 412; sensitivity, 2% [95% CI, 0%-5%]; specificity, 89% [95% CI, 85%-93%]; LR, 0.16 [95% CI, 0.06-0.64]), or headache (n = 323; sensitivity, 3% [95% CI, 0%-7%]; specificity, 80% [95% CI, 75%-85%]; LR, 0.17 [95% CI, 0.06-0.55]). Cyanosis witnessed during the episode was associated with higher likelihood of cardiac syncope (n = 323; sensitivity, 8% [95% CI, 2%-14%]; specificity, 99% [95% CI, 98%-100%]; LR, 6.2 [95% CI, 1.6-24]). Mood changes after syncope (n = 323; sensitivity, 3% [95% CI, 0%-7%]; specificity, 83% [95% CI, 78%-88%]; LR, 0.21 [95% CI, 0.06-0.65]) and inability to remember behavior prior to syncope (n = 323; sensitivity, 5% [95% CI, 0%-9%]; specificity, 82% [95% CI, 77%-87%]; LR, 0.25, [95% CI, 0.09-0.69]) were associated with lower likelihood of cardiac syncope. Two studies prospectively validated the accuracy of the multivariable Evaluation of Guidelines in Syncope Study (EGSYS) score, which is based on 6 clinical variables. An EGSYS score of less than 3 was associated with lower likelihood of cardiac syncope (n = 456; range of sensitivity, 89%-91%, range of specificity, 69%-73%; range of LR, 0.12-0.17; 2 studies). Cardiac biomarkers show promising diagnostic accuracy for cardiac syncope, but diagnostic thresholds require validation.Conclusions and Relevance: The clinical examination, including the electrocardiogram as part of multivariable scores, can accurately identify patients with and without cardiac syncope. [ABSTRACT FROM AUTHOR]

The most important physical finding for diagnosing aortic regurgitation is the presence of an early diastolic murmur. Aortic regurgitation occurs when the aortic valve inside the aorta weakens and allows blood to fall back into the heart. Researchers evaluated 16 studies of the diagnosis of aortic regurgitation and found that the presence of a murmur immediately after the heart contracts was the best indicator of aortic regurgitation. The absence of this murmur was accurate in ruling out aortic regurgitation.

Analyzes the economic aspects of low-dose heparin calcium compared with the low-molecular-weight heparin enoxaparin sodium for the prevention of venous thromboembolism after colorectal surgery. Efficacy and safety of low-dose heparin and enoxaparin; Costs of prophylaxis with heparin and enoxaparin; Costs for outcomes related to thromboembolism and bleeding.

Reviews the available evidence of the precision and accuracy of the clinical examination for abnormal systolic murmurs. Previous efficacy studies reviewed; Findings; Implications; Recommendations.

The authors reply to a letter written in response to the article "Single-patient Rooms for Safe Patient-centered Hospitals."