History
A 60-year-old woman who is the CEO of an electronics company in Silicon Valley, presents for a history and physical required for life insurance authorization. There is no prior history of stroke, neuromuscular disease or a transient ischemic attack (TIA).
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.
Authors and Reviewers
Authored by Dr. Jonathan Keroes, MD and David Lieberman, Developer, Virtual Cardiac Patient. Medically reviewed by Dr. Barbara Erickson, PhD, RN, CCRN. Last Update: 11/29/202160-year-old woman executive requests physical for life insurance authorization