Valvular heart disease Quiz: Ace Your Exams
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A 30-year-old woman comes to the clinic due to shortness of breath on exertion and occasional chest pain. Her medical history is significant for a “heart sound” that was diagnosed as a child after having a prolonged illness. She does not use tobacco, alcohol, or illicit drugs. She immigrated from Peru two years ago with her family. Her temperature is 36.4°C (97.5° F), pulse is 115/min, respirations are 24/min, and blood pressure is 130/60 mm Hg. Physical examination shows pulsations of the nail bed. Cardiac examination shows an abnormal heart sound over the left sternal border on auscultation (see image below). Which of the following maneuvers will likely decrease the intensity of this heart sound?
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