The advanced practice nurse (APRN) is examining a healthy 50 year-old patient with no significant past medical history. The APRN notes a soft grade I out of VI mid-systolic murmur between the left sternal border and the apex. The APRN assumes this is an innocent murmur. What other findings on cardiac exam help to confirm this diagnosis? SELECT ALL THAT APPLY

A. Murmur intensity decreases with sitting is correct because innocent (or physiologic) murmurs often become softer or disappear when the patient sits upright. This helps differentiate them from pathologic murmurs, which may remain unchanged or become louder with positional changes. B. Normal splitting of S2 with inspiration is correct because physiologic splitting of the second heart sound is a normal finding and is consistent with a healthy cardiac examination. An innocent murmur is typically not associated with abnormal heart sounds. C. Absence of a diastolic murmur is correct because innocent murmurs are exclusively systolic. The presence of a diastolic murmur would suggest a pathologic valvular lesion, such as aortic or mitral regurgitation, rather than an innocent murmur. D. Murmur intensity increases with sitting is incorrect because an increase in murmur intensity with sitting or standing is more consistent with pathologic conditions, such as hypertrophic cardiomyopathy, rather than a benign or innocent murmur.