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A 20-year-old female presents to your office for a routine check-up. She has no complaints and her past medical history is insignificant. She is not taking any medications and denies drug abuse. Her blood pressure is 125/65 mmHg and heart rate is 80/min. Cardiac auscultation reveals early diastolic murmur at the left sternal border. What is the next best step in the management of this patient?
A. Electrocardiogram
B. Chest x-ray
C. Coronary angiography
D. Echocardiography
E. No further work-up
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diastolic murmur are always abnormal, needs through work up.
I will start with EKG (CXR may not show anything), and EKG will show ventricular hypertrophy, so, go with AA.
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triplehelix, can you explain how a diastolic murmur can cause ventricular hypertrophy?
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i think, in AR you have diastolic murmur.
AR increased ur prelaod, and heart gets more blood to accomodate, so it will cause ventricular dilataion/hypertrophy because of continuous exposure to highervolume.
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dd i think it is MVP,correct me if i am wrong
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it can't be mvp
mvp is associated with a midsystolic murmur
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aortic regurgitation .........early diastolic murmur ........EKG is the first step of management , so, aaaaaaaaaaaa.............
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Diastolic and continuous murmurs revealed on cardiac auscultation should always be investigated, because the probability that an organic cause is present is high. Midsystolic soft murmurs (grade I-II/IV) in an asymptomatic young patient are usually benign and need no further work-up (Choice E). Transthoracic Doppler echocardiography is a non-invasive and very efficient tool to confirm the presence of flow abnormalities, find the cause, and assess the extent of the problem.
Catheterization and angiography (Choice C) can also reveal the structural defect and assess the severity of the process, but it is invasive; therefore, echocardiography is employed first.
Chest x-ray (Choice B) and electrocardiogram (Choice A) are too non-specific and have limited use in such a case.
Educational Objective:
Diastolic and continuous murmurs as well as loud systolic murmurs revealed on cardiac auscultation should always be investigated using transthoracic Doppler echocardiography. Midsystolic soft murmurs (grade I-II/IV) in an asymptomatic young patient are usually benign and need no further work-up.
