Sandbox:Nuha

• • Holosystolic (pansystolic) murmurs:
    • chronic MR.
    • chronic TR.
    • VSD
    • PDA with pulmonary hypertension
  • Midsystolic (systolic ejection) murmurs
    • Innocent murmur (still's murmur)
    • AS
    • PS
    • HOCM
    • Functional:
      • ASD
      • VSD
      • Straight back syndrome
      • Aortic root dilation
      • Pulmonary artery dilation
      • pulmonary hypertension
      • Hyper-kinetic status:
        • pregnancy
        • Anemia
        • hyperthyroidism
        • exercise
        • A-V fistula
  • Early systolic murmurs
    • Acute MR
    • Acute TR
    • Small VSD
  • Mid to late systolic murmurs

Table 1. Risk Score For Drug-Associated QTc Prolongation

Risk Factors	Points
Age ≥68 y	1
Female sex	1
Loop diuretic	1
Serum K+ ≤3.5 mEq/L	2
Admission QTc ≥450 ms	2
Acute MI	2
≥2 QTc-prolonging drugs	3
sepsis	3
Heart failure	3
One QTc-prolonging drug	3
Maximum Risk Score	21
K+ indicates potassium; and MI, myocardial infarction.

A Tisdale score of ≤ 6 predicts low risk, 7-10 medium risk, and ≥ 11 high risk of drug-associated QT prolongation (Table 2).

Table 2. Risk Levels For Drug-Associated QT Prolongation
Low risk = ≤6 points
Moderate risk = 7-10 points
High-risk = ≥11 points