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Supraclavicular Murmur

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1. Supraclavicular Murmur

Supraclavicular Murmur Supraclavicular Murmur Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Supraclavicular Murmur Supraclavicular (...) Murmur Aka: Supraclavicular Murmur From Related Chapters II. Epidemiology Ages affected: School age III. Signs Intensity: Grade I-II of VI murmur Mid-systolic, soft murmur Location Heard best in supraclavicular area, at carotids Murmur decreased with s pulled back IV. Differential Diagnosis Supra- V. Course Innocent murmur Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Supraclavicular Murmur." Click on the image (or right click

2018 FP Notebook

2. Supraclavicular Murmur

Supraclavicular Murmur Supraclavicular Murmur Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Supraclavicular Murmur Supraclavicular (...) Murmur Aka: Supraclavicular Murmur From Related Chapters II. Epidemiology Ages affected: School age III. Signs Intensity: Grade I-II of VI murmur Mid-systolic, soft murmur Location Heard best in supraclavicular area, at carotids Murmur decreased with s pulled back IV. Differential Diagnosis Supra- V. Course Innocent murmur Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Supraclavicular Murmur." Click on the image (or right click

2015 FP Notebook

3. Chronic Asthma

or allergic conjunctivitis among first-degree relatives. Possible exam findings Wheezing, tachypnea, decreased breath sound intensity, accessory muscle use, intercostal or supraclavicular in-drawing, and nasal flaring (mainly in children) in the absence of an apparent respiratory infection. Chronic Asthma | April 2018 Clinical Practice Guideline Page 2 of 23 Recommendations DIAGNOSIS PRACTICE POINT Any symptoms and signs of variable lower airway obstruction and response to therapy may suggest an asthma (...) respirations and cough; constitutional symptoms; fever unresponsive to normal antibiotics; enlarged lymph nodes; infectious contact; radiographic findings Congenital heart disease Failure to thrive; cyanosis when eating; tachypnea or hepatomegaly; tachycardia; cardiac murmur Cystic fibrosis Nasal polyps, productive cough starting shortly after birth; recurrent chest infections; failure to thrive (malabsorption); loose greasy bulky stools Primary ciliary dyskinesia Recurrent, mild chest infections

2018 Toward Optimized Practice

5. 2017 AHA/ACC Key Data Elements and Definitions for Ambulatory Electronic Health Records in Pediatric and Congenital Cardiology: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards

Association. Stroke . 2014 ; 45 :2160–236. Krediet CTP, van Dijk N, Linzer M, et al. . Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation . 2002 ; 106 :1684–9. McConnell ME, Adkins SB, Hannon DW . Heart murmurs in pediatric patients: when do you refer? Am Fam Physician . 1999 ; 60 :558–64. McCrindle BW, Rowley AH, Newburger JW, et al. . Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health

2017 American Heart Association

7. Chest pain

% of people initially diagnosed with non-cardiac chest pain suffer death or myocardial infarction within 30 days of presentation. People with cardiac risk factors are at a higher risk of cardiac chest pain, so require closer follow up [ ]. Examination How should I examine a person with chest pain? Carry out a physical examination for people with chest pain. This should include: A cardiovascular examination. Heart sounds (for murmurs and pericardial rub). Blood pressure in both arms (possible aortic (...) murmur (aortic value regurgitation); and occasionally a pericardial friction rub. Neurological deficits may be present (such as hemiplegia). Pericarditis/cardiac tamponade Symptoms — sharp, constant sternal pain relieved by sitting forward. Pain may radiate to the left shoulder and/or left arm into the abdomen, and is worse when lying on the left side and on inspiration, swallowing, and coughing. Other symptoms may include fever, cough, and arthralgia. A cardiac tamponade may have associated

2017 NICE Clinical Knowledge Summaries

8. Breathlessness

— acute-onset breathlessness (in 73% of people with PE), pleuritic pain (66%), cough (37%), haemoptysis (13%). Severe cases may lead to dizziness or syncope. Signs — tachypnoea of 20 breaths per minute or greater (in 70% of people with PE), crackles (51%), tachycardia (30%), signs of DVT (11%). Hypoxia, pyrexia, elevated JVP, widely split second heart sound, tricuspid regurgitation murmur, pleural rub, hypotension and cardiogenic shock may also occur. Pneumothorax/tension pneumothorax Risk factors (...) , and supraclavicular or cervical lymphadenopathy. Basis for recommendation Basis for recommendation Clinical features of pulmonary embolism These are based on evidence from a diagnostic study of the clinical features associated with confirmed pulmonary embolism [ ], and guidance from the National Clinical Guideline Centre [ ]. Clinical features of pneumothorax These are based on expert observation reported in the Oxford textbook of medicine [ ]. Clinical features of tension pneumothorax These are based on expert

2017 NICE Clinical Knowledge Summaries

9. Medical Eponyms: Recognizing the Medical Greats

of our predecessors gives us insight into our medical culture. Here are several examples that explore the uniqueness of the eponymous nomenclature. The Sausage Duel Rudolf Virchow (1821-1902) is one of the many physicians whose contributions to the field of medicine led to several eponyms. Just some of the terms carrying his namesake are Virchow Syndrome (a type of amyloid degeneration), Virchow node (left sided supraclavicular lymphadenopathy), and the Virchow triad (the factors that cause (...) , as the “challenged man” of the duel, Virchow picked the weapons. He chose two pork sausages: one infected with Trichinella for Bismarck to use, [vii]. A Bellevue Murmur Most eponyms only use the surname of the honoree, however the Austin Flint murmur is an exception to this rule. Flint (1812-1886) [viii, ix]. [x]. Flint is well known for the heart murmur that bears his name. The murmur is heard with aortic regurgitation, is mid-diastolic/pre-systolic, and is likely caused by the mixing of retrograde aortic flow

2014 Clinical Correlations

10. 2012 ACCF/AHA/ACR/SCAI/SIR/STS/SVM/SVN Key Data Elements and Definitions for Peripheral Atherosclerotic Vascular Disease

Element Name Definition Cardiac rhythm Indicate if the patient has any of the following: ? Normal sinus rhythm ? Atrial fibrillation ? Other Complete vascular examination Carotid, upper, lower extremity pulses, auscultation of the neck for carotid bruits, auscultation of the abdomen and femoral arteries for bruits, palpation of the abdomen and popliteal fossa for aneurysms Complete cardiac examination Palpation and auscultation of the heart, assessing rate, rhythm, presence of murmur, presence

2012 Society for Cardiovascular Angiography and Interventions

11. Aortic Stenosis

sound (best heard at aortic area) Moderate Aortic Stenosis Ejection click (best heard at apex) Early (loudest at right second intercostal space) Transmitted to Supraclavicular, Carotids, Apex Harsh Systolic ejection murmur that peaks later in systole Ends well before A2 heart sound altered Upstroke of the pulse has shudder Delayed, prolonged, low-volume carotid pulsation ( ) 70% and 98% in Aortic Stenosis Apex impulse may be abnormal, accentuated Slightly sustained Presystolic ("a wave") precedes (...) : and in response to V. Symptoms Mild to Moderate stenosis Asymptomatic Severe Obstruction (most common presenting symptom) on exertion progresses to at rest Other presenting symptoms induced VI. Signs Classic Murmur Harsh, late-peaking, crescendo-decrescendo Medium pitch Heard best at right upper (second intercostal space) May also be heard at apex (esp. elderly) May radiate into region Mild Aortic Stenosis Loud ejection click (best heard at apex) Short, early (at right second intercostal space) Loud A2 heart

2018 FP Notebook

13. Allergic and Environmental Asthma (Follow-up)

laryngeal abnormality, although VCD can be present without a localizing wheeze. Increased jugular venous distension may point to an alternative explanation, such as , for the patient’s dyspnea and wheezing. Similarly, palpation of cervical or supraclavicular adenopathy would suggest malignancy, , or infection. Cardiovascular system Findings are normal. Patients with status asthmaticus may have a pulsus paradoxus greater than 10 mm Hg. A murmur, S3 gallop, or rub suggests a cardiac problem and not asthma

2014 eMedicine.com

14. Unstable Angina (Diagnosis)

myocardial dysfunction (eg, systolic blood pressure < 100 mm Hg or overt hypotension, elevated jugular venous pressure, dyskinetic apex, reverse splitting of S2, presence of S3 or S4, new or worsening apical systolic murmur, or rales or crackles) Peripheral arterial occlusive disease (eg, carotid bruit, supraclavicular or femoral bruits, or diminished peripheral pulses or blood pressure) See for more detail. Diagnosis The following laboratory studies are recommended in the evaluation of a patient

2014 eMedicine.com

15. Allergic and Environmental Asthma (Diagnosis)

laryngeal abnormality, although VCD can be present without a localizing wheeze. Increased jugular venous distension may point to an alternative explanation, such as , for the patient’s dyspnea and wheezing. Similarly, palpation of cervical or supraclavicular adenopathy would suggest malignancy, , or infection. Cardiovascular system Findings are normal. Patients with status asthmaticus may have a pulsus paradoxus greater than 10 mm Hg. A murmur, S3 gallop, or rub suggests a cardiac problem and not asthma

2014 eMedicine.com

16. Unstable Angina (Overview)

myocardial dysfunction (eg, systolic blood pressure < 100 mm Hg or overt hypotension, elevated jugular venous pressure, dyskinetic apex, reverse splitting of S2, presence of S3 or S4, new or worsening apical systolic murmur, or rales or crackles) Peripheral arterial occlusive disease (eg, carotid bruit, supraclavicular or femoral bruits, or diminished peripheral pulses or blood pressure) See for more detail. Diagnosis The following laboratory studies are recommended in the evaluation of a patient

2014 eMedicine.com

17. Allergic and Environmental Asthma (Overview)

laryngeal abnormality, although VCD can be present without a localizing wheeze. Increased jugular venous distension may point to an alternative explanation, such as , for the patient’s dyspnea and wheezing. Similarly, palpation of cervical or supraclavicular adenopathy would suggest malignancy, , or infection. Cardiovascular system Findings are normal. Patients with status asthmaticus may have a pulsus paradoxus greater than 10 mm Hg. A murmur, S3 gallop, or rub suggests a cardiac problem and not asthma

2014 eMedicine.com

18. Thoracic Trauma (Follow-up)

hypertension, interscapular murmurs, and diminished or absent pulses in upper or lower extremities are common physical signs. Aortography is the diagnostic procedure of choice if the child is stable (see the image below). Computed tomography scanning is an alternative in that it can be rapidly performed in concert with imaging of the brain, abdomen, and pelvis. Lateral aortograph shows a tear at the level of the ligamentum arteriosum. If the child is stable, aortography is the procedure of choice (...) for 24 hours after injury. Echocardiography is required for any new onset of a murmur. Repair is indicated if ischemia and myocardial dysfunction are severe and salvageable myocardium is found. Most patients with rupture of the myocardium do not reach the hospital alive. However, the injury is occasionally contained by the pericardium, and the child presents in shock from a combination of hemorrhage and cardiac tamponade. [ ] . The mechanism of injury is likely sudden severe compression of the chest

2014 eMedicine Pediatrics

19. Thoracic Trauma (Diagnosis)

hypertension, interscapular murmurs, and diminished or absent pulses in upper or lower extremities are common physical signs. Aortography is the diagnostic procedure of choice if the child is stable (see the image below). Computed tomography scanning is an alternative in that it can be rapidly performed in concert with imaging of the brain, abdomen, and pelvis. Lateral aortograph shows a tear at the level of the ligamentum arteriosum. If the child is stable, aortography is the procedure of choice (...) for 24 hours after injury. Echocardiography is required for any new onset of a murmur. Repair is indicated if ischemia and myocardial dysfunction are severe and salvageable myocardium is found. Most patients with rupture of the myocardium do not reach the hospital alive. However, the injury is occasionally contained by the pericardium, and the child presents in shock from a combination of hemorrhage and cardiac tamponade. [ ] . The mechanism of injury is likely sudden severe compression of the chest

2014 eMedicine Pediatrics

20. Thoracic Trauma (Treatment)

hypertension, interscapular murmurs, and diminished or absent pulses in upper or lower extremities are common physical signs. Aortography is the diagnostic procedure of choice if the child is stable (see the image below). Computed tomography scanning is an alternative in that it can be rapidly performed in concert with imaging of the brain, abdomen, and pelvis. Lateral aortograph shows a tear at the level of the ligamentum arteriosum. If the child is stable, aortography is the procedure of choice (...) for 24 hours after injury. Echocardiography is required for any new onset of a murmur. Repair is indicated if ischemia and myocardial dysfunction are severe and salvageable myocardium is found. Most patients with rupture of the myocardium do not reach the hospital alive. However, the injury is occasionally contained by the pericardium, and the child presents in shock from a combination of hemorrhage and cardiac tamponade. [ ] . The mechanism of injury is likely sudden severe compression of the chest

2014 eMedicine Pediatrics

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