Causes
Clinical
features
Investigations
Therapy
Prognosis
|  | | | Clinical
features |
Look for cardiovascular causes
-
heart murmurs particularly aortic stenosis
b
-
listen for a reduced or absent second heart sound, or a fourth heart sound
-
listen for a murmur loudest in late systole and radiating to the right carotid
Why?
Heart sounds and a murmur loudest in late systole help diagnose aortic stenosis
| Patient |
Target Disorder and
Reference Standard |
Diagnostic Test |
LR+
(95% CI)
|
Post-test Probability |
LR-
(95% CI)
|
Post-test Probability |
elderly patient with syncope
b
(pre-test probability: 5%)
|
aortic stenosis
(imaging studies)
|
reduced or absent 2nd ht sound
|
50
(24 to
100)
|
72% |
0.45
(0.34 to
0.58)
|
2% |
|
|
|
4th heart sound
|
2.5
(2.1 to
3.0)
|
12% |
0.26
(0.14 to
0.49)
|
1% |
|
|
|
any murmur
|
2.4
(2.2 to
2.7)
|
11% |
0.0
(0.0 to
0.13)
|
0% |
|
|
|
murmur loudest in late systole
|
101
(25 to
410)
|
84% |
0.31
(0.22 to
0.44)
|
2% |
|
|
|
radiation to right carotid
|
1.4
(1.3 to
1.5)
|
7% |
0.10
(0.13 to
0.40)
|
0.5% |
|
internal medicine