Heart murmur echocardiography
|
Heart murmur Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Heart murmur echocardiography On the Web |
|
American Roentgen Ray Society Images of Heart murmur echocardiography |
|
Risk calculators and risk factors for Heart murmur echocardiography |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
An echocardiogram is the diagnostic study of choice in a patient with a murmur, and should be obtained in asymptomatic patients with diastolic murmurs, continuous murmurs, holo-systolic murmurs, late systolic murmurs, murmurs associated with ejection clicks or murmurs that radiate to the neck or back as well as a grade 3 or louder midpeaking systolic murmur. An echocardiogram should also be obtained in patients with evidence of myocardial infarction or ischemia, heart failure, congenital heart disease, syncope, endocarditis. Echocardiographic evaluation is not recommended in some murmurs, such as a grade 2 or softer mid-systolic murmur, which can be an "innocent", "benign" or "functional".
Accurate Auscultation versus Echocardiography
The availability of echocardiography does not eliminate the need for properly performed auscultation of the heart.
Although echocardiography provides additional information in many patients and can even provide the correct etiology of various systolic and diastolic murmurs, it is an unnecessary step in many patients with innocent murmurs. Echocardiography can even lead to a false diagnosis of echocardiographic heart disease.
Often, a mild valvular regurgitant jet, detected by color-flow Doppler techniques, is not associated with an audible murmur despite optimal auscultation. Such regurgitant jets usually do not indicate clinical heart disease. Trivial mitral regurgitation can be detected by Doppler in up to 45 % of normal individuals; tricuspid regurgitation in up to 70 %; and pulmonic regurgitation in up to 88 %.
Normal aortic regurgitation is encountered much less frequently, and its incidence increases with advancing age. Newly developed small handheld echocardiographic detectors are highly unlikely to replace the stethoscope. [1]
2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) [2]
Echocardiography in Heart Murmur (DO NOT EDIT) [2]
| Class I |
|
"1. Echocardiography is recommended for asymptomatic patients with diastolic murmurs, continuous murmurs, holo-systolic murmurs, late systolic murmurs, murmurs associated with ejection clicks or murmurs that radiate to the neck or back. (Level of Evidence: C)" |
|
"2. Echocardiography is recommended for patients with heart murmurs and symptoms or signs of heart failure, myocardial ischemia/infarction, syncope, thromboembolism, infective endocarditis, or other clinical evidence of structural heart disease. (Level of Evidence: C)" |
|
"3. Echocardiography is recommended for asymptomatic patients who have grade 3 or louder midpeaking systolic murmurs. (Level of Evidence: C)" |
| Class III |
| "1. Echocardiography is not recommended for patients who have a grade 2 or softer mid-systolic murmur identified as innocent or functional by an experienced observer. (Level of Evidence: C)" |
| Class IIa |
|
"1. Echocardiography can be useful for the evaluation of asymptomatic patients with murmurs associated with other abnormal cardiac physical findings or murmurs associated with an abnormal ECG or chest X-ray. (Level of Evidence: C)" |
|
"2. Echocardiography can be useful for patients whose symptoms and/or signs are likely noncardiac in origin but in whom a cardiac basis cannot be excluded by standard evaluation. (Level of Evidence: C)" |
References
- ↑ Fuster V, Hurst's The Heart. 12th edition, 2008 ISBN 9780071499286
- ↑ 2.0 2.1 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter
|month=ignored (help)