By: Dr. Salim Rezaie
Whether studying for emergency medicine, internal medicine, or USMLE board examinations,
cardiovascular diseases are by far and away one of the biggest organ systems of which
questions get asked. If you pay attention, the first three pearls are all on physical exam findings
and the last two pearls are on disease processes with high morbidity and mortality. I have
attached a review table for each pearl to help simplify the concepts and buzz phrases.
Pearl #1: Know what the maneuvers are that increase and decrease heart murmurs.
In general, you should know all the different maneuvers, their effect, and how they would affect
valve abnormalities. It is helpful to walk yourself through each valve abnormality, and try and
explain why murmurs are increased or decreased, instead of just memorizing a table, which
you will forget in 1 – 2 weeks. That being said, common murmurs that seem to get the most
questions are: HOCM, AS, MVP, and MR.
Cardiac Maneuvers for the Internal Medicine Board Exam
1 | P a g e
K N O W M E D G E
Pearl #2: Know the abnormal arterial pulsations and the disease state with which they