cardiovascular disorders
Cardiac Auscultation
Approach to murmurs
Timing of the murmur in the cardiac cycle correlates with the cause (see table Etiology of Murmurs by Timing ); auscultatory findings correlate with specific heart valve disorders. Various maneuvers (eg, inspiration, Valsalva, handgrip, squatting, amyl nitrate inhalation) can modify cardiac physiology slightly, making differentiation of causes of heart murmur possible (see table All patients with heart murmurs are evaluated by chest x-ray and electrocardiography (ECG). Echocardiography to confirm the diagnosis, determine severity, and track severity over time. Usually, a cardiac consultation is obtained if significant disease is suspected. 