1/14. A continuous murmur after surgery for dissecting ascending aortic aneurysm.We report a case of a subcutaneous arteriovenous fistula that developed after aortic surgery. A careful physical examination and the selective use of imaging tests can differentiate this relatively benign complication from the more serious causes of a continuous murmur in this setting.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/14. eponyms and the diagnosis of aortic regurgitation: what says the evidence?BACKGROUND: Chronic aortic regurgitation can lead to significant morbidity and mortality. For more than a century, numerous eponymous signs of aortic regurgitation have been described in textbooks and the literature. PURPOSE: To compare current textbook content with the peer-reviewed literature on the eponymous signs of aortic regurgitation and to assess the role of these signs in clinical practice. DATA SOURCES: 11 textbooks, medline (1966 through October 2002), and bibliographies of textbooks and relevant papers. STUDY SELECTION: English-language reports that were related to the properties of a sign on physical examination, incorporated more than 10 adults, and did not involve prosthetic heart valves or acute aortic regurgitation. DATA EXTRACTION: Three investigators independently analyzed relevant textbook extracts and 27 reports, using predetermined qualitative review criteria. Data relating to diagnostic accuracy and properties of the index test were also extracted. DATA SYNTHESIS: Twelve eponymous signs were described as having varying degrees of importance by textbook authors. Only the Austin Flint murmur, the Corrigan pulse, the Duroziez sign, and the Hill sign had sufficient original literature for detailed review. Most reports were low quality, with varying sensitivities for all signs. Except for the Hill sign, specificity tended to be poor. Evidence for the Hill sign also suggested a correlation between the popliteal-brachial gradient and aortic regurgitation severity. CONCLUSIONS: Prominent textbook support of the eponymous signs of aortic regurgitation is not matched by the literature. Clinicians and educators should update and improve the evidence for these signs to ensure their relevance in current medical practice.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/14. Ruptured aneurysm of the sinus of valsalva into the right atrium. An uncommon congenital heart defect.rupture of an aneurysm of the sinus of valsalva is an uncommon heart defect. A continuous murmur may be the first clinical sign of this rupture. Additional imaging techniques, and in the first place echocardiography, can be used to confirm the diagnosis. We present a case where, at the age 53 years, the diagnosis was made of a ruptured sinus of valsalva into the right atrium, with a typical windsock image on echocardiogram. Although several cases of a ruptured sinus of valsalva are reported in the literature, it is still an underdiagnosed condition because it is frequently missed during physical examination.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/14. The heart as a bass organ.Many florid physical signs of aortic regurgitation have been described. We describe a florid investigational finding of virtually monotonous intracardiac reverberation originating at the aortic valve leaflets.- - - - - - - - - - ranking = 0.058112944484682keywords = physical (Clic here for more details about this article) |
5/14. Fistulous connection between internal mammary graft and pulmonary vasculature after coronary artery bypass grafting: a rare cause of continuous murmur.A 58-year-old male who had undergone coronary artery bypass grafting (CABG) using left internal mammary artery and a sequential saphenous vein graft 2 years ago presented with new onset angina. His initial physical examination revealed an unexpected continuous murmur over the left sternal border, and two-dimensional echocardiography has failed to identy the cause. cardiac catheterization then performed and revealed patent left internal mammary artery and saphenous vein grafts. Besides, selective injection of the left internal mammary artery graft also showed a fistula formation between left internal mammary artery graft and pulmonary vasculature of the left upper lobe. He was managed conservatively because of the severely diseased left anterior descending artery distal to internal mammary artery anastomosis and low pulmonary artery pressure. The development of fistulous connection between internal mammary artery and pulmonary vasculature is an extremely rare complication following CABG. patients with such fistulae usually present with chest pain due to coronary steal syndrome. A new heart sound, especially a continuous murmur, may be detected during physical examination. Surgical correction is indicated in the event of refractory angina, growing fistula causing heart failure or endarteritis. Otherwise, a conservative approach with instruction of the patient for prophylactic precautions of subacute bacterial endocarditis may be recommended for asymptomatic patients.- - - - - - - - - - ranking = 2keywords = physical examination, physical (Clic here for more details about this article) |
6/14. Dilated cardiomyopathy in a 7-year-old girl.Pediatric patients with dilated cardiomyopathy can initially be present for medical attention with non-specific and misleading signs and symptoms. We present the case of a 7-year-old girl with vague complaints of fever, vomiting, and abdominal pain and cardiac murmur on physical exam who progressed to congestive heart failure before her dilated cardiomyopathy was diagnosed. Clinicians should maintain a high index of suspicion for dilated cardiomyopathy in any patient with cardiac murmur and systematic symptoms.- - - - - - - - - - ranking = 0.058112944484682keywords = physical (Clic here for more details about this article) |
7/14. Aortic leaflet perforation during radiofrequency ablation.A 15-year-old girl underwent successful radiofrequency ablation of an accessory pathway. Following ablation, a new III/VI diastolic murmur was noted. echocardiography revealed a perforated aortic leaflet, with a small amount of adherent valvular tissue and trivial aortic insufficiency by color Doppler. The patient remains asymptomatic. We are not aware of any similar complication from electrophysiological study, catheter ablation, coronary angiography, or percutaneous transluminal coronary angioplasty. We speculate that the current state of catheter technology contributed significantly to this complication. This case illustrates the need for using care in crossing the valve, continued advances in catheter technology to reduce the incidence of complications, and careful physical examination prior to and following attempts at ablation.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/14. A thrilling case of hiatus hernia.A 65 year old woman was found to have a left parasternal heave and a systolic murmur associated with a thrill. A chest radiograph, echocardiogram and gastrograffin swallow demonstrated a massive obstructed hiatus hernia which displaced the heart anteriorly. Aspiration of the contents of the hernia led to complete resolution of the physical signs. Possible mechanisms for their production are discussed.- - - - - - - - - - ranking = 0.058112944484682keywords = physical (Clic here for more details about this article) |
9/14. Venous systolic thrill and murmur in the neck: a consequence of severe tricuspid insufficiency.A palpable venous systolic thrill and murmur at the base of the neck are described as new physical findings in five patients with severe tricuspid regurgitation. In two of these patients, the tricuspid valve had been resected as treatment for infective endocarditis related to intravenous drug abuse. The third patient had severe chronic pulmonary disease with right heart failure. The fourth patient had a complex congenital defect in which the mitral valve served as the venous atrioventricular valve and was severely incompetent. The fifth patient suffered from long-standing rheumatic mitral and tricuspid disease with pulmonary hypertension 10 years after placement of a mitral prosthesis. From these observations, it is apparent that pulsatile retrograde flow in the cervical veins resulting from severe right-sided atrioventricular valve incompetence can produce a palpable systolic thrill and murmur at the base of the neck.- - - - - - - - - - ranking = 0.058112944484682keywords = physical (Clic here for more details about this article) |
10/14. Anomalous origin of the right coronary artery from the pulmonary artery.Three patients with anomalous origin of the right coronary artery from the pulmonary artery are presented together with a review of the 14 patients with this anomaly previously reported. One of the current patients is the youngest to be diagnosed before operation and the youngest to undergo corrective operation. Although the lesion is usually asymptomatic, it may contribute to sudden death. The only suggestive physical finding is a continuous murmur with diastolic accentuation, which is present only in some patients. There are no diagnostic electrocardiographic or chest roentgenographic changes. diagnosis is made best by selective left coronary arteriography showing retrograde filling of the right coronary artery from collateral vessels. Operative repair should consist either of direct reimplantation of the proximal right coronary artery into the aortic root or of saphenous vein bypass graft to the coronary artery with ligation of its origin. Operation is recommended when the lesion is recognized.- - - - - - - - - - ranking = 0.058112944484682keywords = physical (Clic here for more details about this article) |
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