Approach to a murmur (pediatrics) Quiz: Ace Your Exams

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A 14-year-old boy presents to the pediatrician’s office for a sports clearance evaluation prior to football tryouts. The boy has no symptoms. The parent reports that the family history is significant for a grandparent who died unexpectedly at age 38 from a “thickened heart” that was seen on autopsy. On physical examination, temperature is 37°C (98.6°F), heart rate is 66/min, blood pressure is 111/63 mmHg, respirations are 14/min, and oxygen saturation is 99% on room air. The patient is well-appearing and in no acute distress. Cardiac examination reveals a regular heart rate. Which of the following murmurs would indicate the patient has the same condition as his grandfather?

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Early diastolic, high-pitched, blowing murmur heard best at the left sternal border

Blowing systolic ejection murmur heard best at the left upper sternal border that radiates to the back

Holosystolic murmur heard best at the left lower sternal border

Systolic ejection murmur heard best at the left lower sternal border, that is louder with Valsalva

Continuous murmur heard below the clavicles that disappears when supine