His chest is clear and careful cardiac examination revealed a 2/6 early diastolic murmur
in aortic region.
A decrescendo diastolic murmur
was maximal in the third left intercostal space.
Physical findings such as irregular heart rhythms, any diastolic murmur
, systolic murmurs that increase with Valsalva or decrease in the supine position, and findings consistent with Marfan syndrome (Table 3) should also be treated as indicators for further cardiac workup.
On his physical examination blood pressure was 110/70 mmHg, pulse rate was 80/min and the diastolic murmur
was heard on the mesocardiac area.
Examination revealed elevated neck veins, ankle edema, a systolic ejection murmur in the second left intercostal space, and a short low-pitched diastolic murmur
along the left sternal edge.
Signs of right ventricular failure (edema, ascites) may be evident, and a harsh holosystolic murmur, a diastolic murmur
, tachycardia, tachypnea, thrills, polycythemia, anemia, and leukocytosis can all be detected on presentation but again are nonspecific.
A 25-year-old white man with a history of congenital aortic valve stenosis, surgically corrected at age 8, presented with fever and worsening of his diastolic murmur