I’m getting close to the period where my test date will arrive. the nights of studying and reading in between patients at the local echo lab will pay off in spades. Getting a passing score and becoming certified as an echocardiographer looks to be within my grasp.
The sixth case I will review will be about a condition called “congenital aortic stenosis/regurgitation”.
History
A 21-year old male presents to the emergency room with complaints of dyspnea (shortness of breath) and extreme exhaustion upon exertion.There is no history of rheumatic fever, chest pain, orthopnea (difficulty breathing while lying down), or edema (excessive fluid). He complains of palpitations and recalls a prior doctor telling him his heart sounds are not normal.
Physical Examination
Blood pressure is 150/50 and pulse is 78 bpm. Pulses are noted to be prominent. A hyperdynamic left ventricular impulse is left of the midclavicular line. S1 and S2 are normal. a grade 2/6 systolic ejection murmur is heard at the right upper sternal border. A grade 4/5 diastolic decrescendo murmur is heard along the left sternal border. a brisk pulse is noted in the fingers that fades away suddenly. The EKG demonstrates LVH and the CXR shows mild-moderate cardiomegaly.
After reading this case, the main points of interest are what occurs during the physical exam. Listening and feeling the different heart sounds is a way of finding out which way to possible go for this diagnosis. An echocardiogram will let the cardiologist know the level of aortic stenosis or regurgitation, and how to progress. An enlarged heart can only make the internal structures perform less efficiently.
