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Kevin M. Fosnocht, MD
Hospital of the University of Pennsylvania Philadelphia

JAMA. 1997;277(20):1593-1594.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—Dr Etchells and colleagues¹ have published a thorough review of studies assessing the available evidence of the precision and accuracy of the clinical examination for abnormal systolic murmurs. Their conclusions, however, beg the question posed in their title: "Does this patient have an abnormal systolic murmur?" As the authors point out, "clinicians are primarily concerned whether a systolic murmur indicates a cardiac abnormality," ie, which patients need further evaluation (such as echocardiography) or therapeutic intervention (such as antibiotic prophylaxis with procedures). Two studies not included in the MEDLINE search by the authors address this issue.

Roldan et al² studied the value of the cardiovascular physical examination for detecting valvular heart disease in asymptomatic subjects. They found that, of 143 subjects younger than 61 years (68 apparently healthy and 75 with no cardiac symptoms but with connective tissue diseases), a single cardiologist's determination of a murmur . . . [Full Text PDF of this Article]

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