American Board of Internal Medicine (ABIM) Certification Practice Exam

What type of murmur requires further evaluation based on specific criteria?

1. Asymptomatic diastolic murmur

2. Holosystolic murmur in asymptomatic patients

3. Asymptomatic systolic murmur grade 2/6

4. Grade 3/6 or higher systolic murmurs

The correct answer is: Grade 3/6 or higher systolic murmurs

The requirement for further evaluation of heart murmurs is often associated with their intensity and characteristics. A systolic murmur that is graded at 3/6 or higher is notable because it indicates a louder sound generated during ventricular contraction. Such murmurs can be indicative of significant underlying cardiac pathology. Murmurs that are grade 3/6 or higher merit further investigation due to the increased likelihood of associations with structural heart issues, such as valvular heart disease or congenital heart defects. Even in asymptomatic individuals, the presence of a louder murmur can suggest a need for echocardiographic evaluation or other diagnostic assessments to understand the underlying cause and to rule out any serious conditions that might not present with symptoms. In contrast, other types of murmurs listed, such as asymptomatic diastolic murmurs or holosystolic murmurs in asymptomatic patients, may not necessarily indicate significant pathology requiring immediate further evaluation unless other clinical signs or symptoms are present. Additionally, an asymptomatic systolic murmur graded at 2/6 is generally considered benign, and routine follow-up rather than advanced investigation is usually adequate.