Differentiating systolic heart murmurs can be challenging. The murmur associated with aortic stenosis is transmitted to the neck, whereas the murmur of mitral regurgitation is not. — Donna Berthoff, PA-C, FNP-BC, Syracuse, N.Y. (182-10)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.