Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 181: A 64-Year-Old with Fatigue and Low-Grade Fevers
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Feb 5, 2026 A clinical case about a 64-year-old with fatigue, low fevers, and weight loss sparks a discussion of a new holosystolic murmur at the apex radiating to the axilla. Conversation covers murmur timing, causes, grading, and how maneuvers like hand grip, inspiration, and Valsalva change murmur intensity. They conclude the findings suggest mitral regurgitation and discuss concern for endocarditis.
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How Murmurs Originate And What To Observe
- Heart murmurs arise from turbulence, flow through narrowed or dilated orifices, or backward flow through incompetent valves or defects.
- Timing, location, radiation, intensity, and configuration help identify murmur etiology at the bedside.
Recognize Mitral Regurgitation By Location
- A holosystolic grade 3/6 murmur at the apex radiating to the axilla indicates mitral regurgitation.
- Expect this murmur to increase with sustained hand grip due to higher afterload.
Use Maneuvers To Differentiate Murmurs
- Use bedside maneuvers that change afterload, venous return, or intrathoracic pressure to characterize murmurs.
- Apply hand grip, inspiration, and Valsalva strategically to distinguish mitral, tricuspid, aortic, and HOCM findings.
