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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Approach to the Patient with a Murmur
John Landefeld1, Melody Tran-Reina1, Mark Henderson1
1Department of Internal Medicine, UC Davis School of Medicine, 4150 V Street, Suite 2400, Sacramento, CA 95817, USA.
Insights
A thorough cardiac physical exam is crucial for diagnosing valvular heart disease. Specific murmurs, like diastolic murmurs, signal significant valve issues requiring further echocardiography investigation.
Area of Science:
- Cardiology
- Internal Medicine
- Diagnostic Medicine
Background:
- Valvular heart disease (VHD) affects numerous patients, presenting with or without symptoms.
- Cardiac physical examination is a cornerstone in identifying patients needing further VHD evaluation.
- Understanding cardiac findings is essential for effective VHD management.
Purpose of the Study:
- To review key components of the cardiac examination for VHD.
- To highlight significant cardiac findings, including various murmurs and their implications.
- To guide appropriate diagnostic pathways for suspected VHD.
Main Methods:
- Systematic review of cardiac examination techniques for VHD.
- Analysis of clinical findings associated with common valvular pathologies.
- Discussion of diagnostic utility of physical examination findings.
Main Results:
- Diastolic murmurs strongly indicate significant valvular pathology requiring echocardiography.
- Systolic murmurs, while common, require careful examination for accurate diagnosis and cost-effective care.
- Specific findings correlate with conditions like aortic stenosis, mitral valve prolapse, and hypertrophic cardiomyopathy.
Conclusions:
- A comprehensive cardiac physical examination is vital for efficient VHD diagnosis.
- Distinguishing murmur types and associated findings guides further investigation.
- Expert physical examination facilitates timely and appropriate management of valvular heart disease.
Abstract:
Patients with valvular heart disease may present with or without symptoms. A thorough cardiac physical examination can identify patients who require further evaluation and management. Although the utility of different cardiac findings varies widely, diastolic murmurs indicate important underlying valvular pathology requiring further investigation, typically with echocardiography. The proper examination of patients with systolic murmurs, the most common murmurs in clinical practice, is fundamental to cost-effective care. We will review the key components of the cardiac examination and findings relevant to functional murmurs, aortic stenosis, mitral valve prolapse and regurgitation, tricuspid regurgitation, hypertrophic cardiomyopathy, aortic regurgitation, and mitral stenosis.
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