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Old 06-28-2012
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Heart elderly with systolic ejection murmur...next step ?

A 72-year-old woman is seen during a routine office evaluation to establish care. Medical history includes hypertension and hyperlipidemia. There is a family history of coronary artery disease. The patient does not smoke, is active, and walks daily. She does not have angina, dyspnea, fatigue, or edema.

On physical examination, blood pressure is 128/70 mm Hg. There are no carotid bruits. Cardiac examination shows a normal S1, a physiologically split S2, and a grade 2/6 midsystolic murmur that does not radiate and is best heard at the second right intercostal space. The remainder of the physical examination is normal.

Which of the following diagnostic tests is most appropriate at this time?

A Electron-beam cardiovascular CT scanning
B 24-Hour ambulatory electrocardiographic monitoring
C Transthoracic echocardiography
D Treadmill stress echocardiography
E No further testing at this time
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Old 06-28-2012
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E- no furthur testing at this time

its asymptomatic aortic stenosis.... age related

if it becomes symptomatic then echo -- to see for valve replacement etc
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C?

Need to determine degree of stenosis.
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Old 06-29-2012
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its a 2/6 grade murmur and doesn't even radiate to carotids... so at the most it is aortic sclerosis without stenosis , even if you want to consider the possibility of organic valve problem .hence no further work up .
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E No further testing at this time

P.S. a grade 2/6 midsystolic murmur is not investigated unless there are symptoms.
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