In conducting heart auscultation, several factors must be considered to get the correct diagnosis. A warm and quiet environment is vital as the clinician uses a stethoscope with a long rubber tubing with a stiff diaphragm ( Shojaeifard, Pouraliakbar & Houshmand, 2018) . The pitch, duration, primary location, intensity, and configuration of the murmur must be considered. Often grade iv and above murmurs are accompanied by a palpable thrill which the clinician should observe. In making a diagnosis, systolic murmurs should not be taken in isolation, but instead, other cardiovascular examination elements are relevant in determining the cause of the problem ( Shojaeifard et al., 2018) . Also, the other abnormalities of the heart would show the severity of the problem.
Based on the available information, the diagnosis for the patient would be valve disease. Heart murmurs are a sign of turbulence as blood flow through heart valves or those near the heart. Heart murmurs happen when valves fail to close tightly, causing regurgitation of blood or due to stenosis where the valves are stiff or narrowed ( Cutter et al., 2015) . The distribution of the murmurs on the chest wall according to the left parasternal base is also vital in diagnosis and treatment.
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Finally, the behavior of the patient is a vital factor to consider during the diagnosis and treatment of the patient. Valve disease is often related to heart attack, heart muscle disease, high blood pressure, aortic aneurysms, and coronary artery disease ( Cutter et al., 2015) . Most of these conditions are related to lifestyle factors such as diet and physical activity. Consequently, they are important indicators and help confirm the problem in the patient. Often, a balloon valvuloplasty is used to relieve the symptoms of valve disease. However, surgery to repair or replace defective valves and drugs is sufficient for a complete cure.
References
Cutter, D. J., Schaapveld, M., Darby, S. C., Hauptmann, M., van Nimwegen, F. A., Krol, A. D., ... & Aleman, B. M. (2015). The risk for valvular heart disease after treatment for Hodgkin lymphoma. JNCI: Journal of the National Cancer Institute , 107 (4).
Shojaeifard, M., Pouraliakbar, H. R., & Houshmand, G. (2018). The asymptomatic young man with an incidental murmur. Heart , 104 (15), 1307-1307.
