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The cardiac examination is almost always abnormal purchase mg bupropion with mastercard depression symptoms dsm 5, usually with a pathologic systolic murmur and possible diastolic rumble generic mg bupropion depression symptoms head pressure. Ventricular septal defects cause holosystolic order bupropion mastercard depression symptoms nightmares, regurgitant murmurs, usually at the left mid to lower sternal border or at the apex, depending on the location of the defect. The diastolic rumble is produced by the large flow volume crossing the mitral valve. Occult Congenital Defects Atrial septal defects often go undetected for several years, as they rarely cause symptoms in infancy but may result in decreased exercise tolerance in the adoles- cent. The classic findings on cardiac examination are a fixed and widely split S2, best heard at the mid to upper sternal border. Obstructive lesions such as aortic stenosis or coarctation that present later, are nonductal dependent, progressive lesions that rarely cause symptoms until severe.

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