Doppler Echocardiography in the Evaluation of a Heart Murmur

A 91-year-old womanwith a history of hypertension, hypercholesterolemia, and stage 3 renal insufficiencypresented for a routine office visit. She reportedno chest pain, dyspnea on exertion, presyncope, orthopnea, paroxysmal nocturnal dyspnea, or pedal edema. Physical examination demonstrated bloodpressure of 140/76mmHgand a heart rate of 72/min. Carotid upstrokeswere slightly delayedwith a transmittedmurmur. Lungswere clear bilaterally. Cardiac examination demonstrated a regular rate and rhythm, normal S1, 3/6 harsh, late-peaking systolic murmur that radiated to the carotids with soft A2, 2/4 diastolic decrescendo murmur at the left lower sternal border, and 2/6 holosystolic murmur at the apex. Distal pulses were 2+ bilaterally. There was no edema. A 2-D and Doppler transthoracic echocardiogram (TTE) was performed to assess valvular function (Table; Interactive).