11-20-2006, 03:58 PM
A 21-year-old woman is referred for evaluation of a murmur that was detected during an athletic screening examination. She has no significant medical history. As part of the training for her college cross-country program, she runs 3 to 8 miles daily and participates in moderate-intensity resistance training. She has no exertional chest pain or episodes of hotheadedness or syncope. She has shortness of breath only during wind sprints, when she runs short intervals faster than competition pace. She has no family history of premature cardiac disease or sudden cardiac death. On physical examination, her heart rate is 52/min and blood pressure 98/60 mm Hg. Cardiac auscultation shows a 2/6 crescendo-decrescendo murmur that is loudest in the left upper sternal border.
Which of the following findings would suggest that an echo cardiogram is warranted?
A. A murmur that decreases in intensity during Valsalva maneuver
B. Shortness of breath during unusual exertion
C. A soft S 3
D. A murmur that peaks in intensity in the later half of systole
E. A split S 1
Which of the following findings would suggest that an echo cardiogram is warranted?
A. A murmur that decreases in intensity during Valsalva maneuver
B. Shortness of breath during unusual exertion
C. A soft S 3
D. A murmur that peaks in intensity in the later half of systole
E. A split S 1