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60-year-old woman with constipation of three months

History

A 60-year-old woman with constipation of three months duration. Her exercise tolerance has been decreased. She has coarse, rough skin.

Physical Exam

Blood pressure is increased. Pulse rate is 80 bpm. Swollen ankles. Lung sounds are normal.

Exam

Use the 'auscultation' link above to virtually listen to this patient's heart and carotid sounds.



Auscultation Tips

Significant independent predictors of the presence of a confirmed cardiac lesion:

  • A loud murmur of intensity 3 or greater.
  • Best heard at the pulmonic location (2LICS).
  • Harsh sound.
  • Pansystolic murmur.
  • Systolic click.
  • Abnormal second heart sound - fixed splitting during respiration.

60-year-old woman with constipation of three months

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