Another murmer?be careful

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Another murmer?be careful

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marehan71
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02/21/10 - 05:30 AM

A 52 yr old patient came to your office for regular checkup. he has history of left femur fracture 10 yrs ago which was treated successfully, had appendectomy done at the age of 18 years. was 2 pack smoker 5 years ago for 20 years . drinks alcohol socially. has a wife and 3 children and he says to be in monogamous relationship with his wife since 25 yrs. on PE you note BP 138/93, Pulse 82bpm, respiration 14/min regular pulse.
on chest auscultation you note systolic murmur gradeI/VI in intesinty. remaining PE is unremarkable.
what is the most appropriate course of action?

A-do CXR
B-do EKG
C-do Echocardiography
D-do CXR and EKG and decide depending on the result
E-do CBC and carefully take nutrition history
F-reassure him as this is not a big problem

hero
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02/21/10 - 05:43 AM

kauraabhimanyu
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02/21/10 - 05:55 AM

f nothing wrong with him.

drlilac
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02/21/10 - 07:11 AM

drsensitive
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02/21/10 - 01:28 PM

its f

maoudoody
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02/21/10 - 02:35 PM

hero
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02/22/10 - 01:44 AM

Fred33 wrote:
why E hero and maoudoody ?

52 yo male, h/o smoking, systolic murmur grade 1 can be from anemia, anemia at his age can be from number of reasons, why not CBC for my pt once in a while?

marehan71
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02/22/10 - 11:20 PM

this question is from an old book I found in my library.
It says that correct answer is D.
expl. goes like Age above 40, mid systolic murmurs and grade1 and2 diastolic and holosystolic murmurs are investigated with CXR and EKG both if any abnormality than Echo if no abnormality no further workup needed
in search of answer this is what I found in harrison's
"The majority of heart murmurs are midsystolic and soft (grades I to II/VI). When such a murmur occurs in an asymptomatic child or young adult without other evidence of heart disease on clinical examination, it is usually benign and echocardiography is not generally required. On the other hand, two-dimensional and Doppler echocardiography are indicated in patients with loud systolic murmurs (grades III/VI), especially those that are holosystolic or late systolic, and in most patients with diastolic or continuous murmurs"
also there is an algorithm In harrison's which has mentioned the same thing.(fig 219-1)17th edition

drlilac
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02/23/10 - 05:05 AM

I see. It makes sense. It depends on the age. Thanks smiling face

maoudoody
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02/23/10 - 06:42 AM

#10

y dont we go for echo directly? simple test done in the office and more accurate instead of sending the patient to radiology and then back for an ekg?

drlilac
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02/23/10 - 08:39 AM

#11

Because basic work up should be done first esp for an asymptomatic person.

studyin4ck
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02/25/10 - 08:48 PM

#12

wow this is amazing. u world says that if you have a systolic murmur grade 1 or grade 2...just reassure...new concept...thanks. .

hero
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02/27/10 - 09:49 AM