Heart murmur laboratory findings: Difference between revisions

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{{Heart murmur}}
{{Heart murmur}}
{{CMG}}
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==Overview==  
==Overview==  
In a patient with a heart murmur, a [[complete blood count]] ([[CBC]]) may be useful in evaluating anemia as a contributing condition, [[thyroid function tests]] may be checked to rule out [[hyperthyroidism]], and blood cultures may be helpful in excluding [[endocarditis]].
In a patient with a heart murmur, a [[complete blood count]] ([[CBC]]) may be useful in evaluating anemia as a contributing condition, [[thyroid function tests]] may be checked to rule out [[hyperthyroidism]], [[blood cultures]] may be helpful in excluding [[endocarditis]], and a [[pregnancy test]] to exclude [[pregnancy]].
 
== Summary of possible finding ==
{| class="wikitable"
!Murmur
!chest x-ray
!ECG
!Cardiac MRI
!Cardiac catheterization
|-
|MR
|
* chronic [[mitral regurgitation]] (MR) an enlargement of the [[left atrium]] and the [[left ventricle]]. 
* In acute MR, [[pulmonary edema]] is present and the heart is not enlarged.<ref name="MR">Mitral regurgitation https://radiopaedia.org/articles/mitral-valve-regurgitation (2016) Accessed on December 13, 2016</ref>
|
* In chronic mitral regurgitation (MR), signs of [[left ventricular hypertrophy with strain]], [[left atrial enlargement]], and [[pulmonary hypertension]] may be observed on the resting [[electrocardiogram]] ([[ECG]]). <ref name="pmid2861980">{{cite journal |vauthors=Murphy PJ |title=Searching in the dark |journal=Drug Metab. Dispos. |volume=13 |issue=3 |pages=269–71 |date=1985 |pmid=2861980 |doi= |url=}}</ref><ref name="isbn0-7637-6405-1">{{cite book |author=O'Keefe, James |title=The Complete Guide to ECGS |publisher=Jones & Bartlett Pub |location= |year=2008 |pages= |isbn=0-7637-6405-1 |oclc= |doi= |accessdate=}}</ref>
|[[Cardiac magnetic resonance]] ([[CMR]]) may be beneficial to evaluate the structure and function of the [[left atrium]] and [[left ventricle]] as well as the severity of the mitral regurgitation when [[echocardiography]] findings are inconclusive.<ref name="pmid24589852">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2014 | volume= 129 | issue= 23 | pages= 2440-92 | pmid=24589852 | doi=10.1161/CIR.0000000000000029 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589852  }}</ref>
|[[Mitral regurgitation cardiac catheterization]]
|-
|MS
|[[Chest X-ray]] shows [[left atrial enlargement]] (double [[right heart]] border), a prominent [[pulmonary artery]] (suggestive of an elevation in the [[pulmonary artery]] pressure), and [[kerley lines]] (suggestive of interstial [[pulmonary edema]]).<ref name="MR2">Mitral regurgitation https://radiopaedia.org/articles/mitral-stenosis Accessed on December 7, 2016</ref><ref name="pmid7790325">{{cite journal| author=Velusamy M, Mullens ML, Harrell JE, Talley JD| title=The chest x-ray in mitral stenosis. | journal=J Ark Med Soc | year= 1995 | volume= 91 | issue= 12 | pages= 604-5 | pmid=7790325 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7790325  }}</ref>
|
* mitral stenosis might have no significant abnormalities. Findings suggestive of [[left atrial enlargement]] and hypertrophy might be present, such as a broad, bifid [[P wave]] in lead II.<ref name="pmid20435842">{{cite journal| author=Maganti K, Rigolin VH, Sarano ME, Bonow RO| title=Valvular heart disease: diagnosis and management. | journal=Mayo Clin Proc | year= 2010 | volume= 85 | issue= 5 | pages= 483-500 | pmid=20435842 | doi=10.4065/mcp.2009.0706 | pmc=2861980 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20435842  }}</ref>
* The [[ECG]] might demonstrate findings of [[pulmonary hypertension]] and [[right ventricular hypertophy]]. 
|[[Cardiac magnetic resonance]] (CMR) may be helpful to evaluate the structure and function of the [[left atrium]] and [[left ventricle]] as well as the severity of the mitral stenosis when [[echocardiography]] findings are inconclusive.
|[[Mitral stenosis cardiac catheterization]]
|-
|AR
|[[Chest X-ray]] findings may include [[left ventricular enlargement]], [[cardiomegaly]], prominent [[aortic root]] with valvular [[calcification]]. If aortic regurgitation is severe, signs of [[pulmonary edema]] may be present.<ref name="pmid9870202">{{cite journal| author=Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD et al.| title=ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). | journal=J Heart Valve Dis | year= 1998 | volume= 7 | issue= 6 | pages= 672-707 | pmid=9870202 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9870202  }}</ref>
|In aortic regurgitation, the [[EKG|electrocardiography]] findings are nonspecific. it may include [[left axis deviation]] and signs of [[left ventricular hypertrophy]].<ref name="pmid98702022">{{cite journal| author=Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD et al.| title=ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). | journal=J Heart Valve Dis | year= 1998 | volume= 7 | issue= 6 | pages= 672-707 | pmid=9870202 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9870202  }}</ref>
|[[Aortic regurgitation cardiac MRI]]
|
|-
|AS
|Chest X-ray findings associated with aortic stenosis include [[left ventricular enlargement]] and calcification of the aortic valve.<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e1-121 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677  }}</ref><ref>{{Cite journal
| author = [[Robert O. Bonow]], [[Blase A. Carabello]], [[Kanu Chatterjee]], [[Antonio C. Jr de Leon]], [[David P. Faxon]], [[Michael D. Freed]], [[William H. Gaasch]], [[Bruce W. Lytle]], [[Rick A. Nishimura]], [[Patrick T. O'Gara]], [[Robert A. O'Rourke]], [[Catherine M. Otto]], [[Pravin M. Shah]] & [[Jack S. Shanewise]]
| title = 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
| journal = [[Journal of the American College of Cardiology]]
| volume = 52
| issue = 13
| pages = e1–142
| year = 2008
| month = September
| doi = 10.1016/j.jacc.2008.05.007
| pmid = 18848134
}}</ref>
|No specific findings on the [[EKG]], the presence of [[left ventricular hypertrophy]] ([[LVH]]) secondary to chronic pressure overload of the [[left ventricle]] due to [[aortic stenosis]] is commonly observed.<ref>{{Cite journal
| author = [[Markku Kupari]], [[Heikki Turto]] & [[Jyri Lommi]]
| title = Left ventricular hypertrophy in aortic valve stenosis: preventive or promotive of systolic dysfunction and heart failure?
| journal = [[European heart journal]]
| volume = 26
| issue = 17
| pages = 1790–1796
| year = 2005
| month = September
| doi = 10.1093/eurheartj/ehi290
| pmid = 15860517
}}</ref>
|[[Aortic stenosis MRI]]
|[[Aortic stenosis cardiac catheterization]]
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


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Latest revision as of 21:47, 4 October 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD[2]


Overview

In a patient with a heart murmur, a complete blood count (CBC) may be useful in evaluating anemia as a contributing condition, thyroid function tests may be checked to rule out hyperthyroidism, blood cultures may be helpful in excluding endocarditis, and a pregnancy test to exclude pregnancy.

Summary of possible finding

Murmur chest x-ray ECG Cardiac MRI Cardiac catheterization
MR Cardiac magnetic resonance (CMR) may be beneficial to evaluate the structure and function of the left atrium and left ventricle as well as the severity of the mitral regurgitation when echocardiography findings are inconclusive.[4] Mitral regurgitation cardiac catheterization
MS Chest X-ray shows left atrial enlargement (double right heart border), a prominent pulmonary artery (suggestive of an elevation in the pulmonary artery pressure), and kerley lines (suggestive of interstial pulmonary edema).[5][6] Cardiac magnetic resonance (CMR) may be helpful to evaluate the structure and function of the left atrium and left ventricle as well as the severity of the mitral stenosis when echocardiography findings are inconclusive. Mitral stenosis cardiac catheterization
AR Chest X-ray findings may include left ventricular enlargement, cardiomegaly, prominent aortic root with valvular calcification. If aortic regurgitation is severe, signs of pulmonary edema may be present.[8] In aortic regurgitation, the electrocardiography findings are nonspecific. it may include left axis deviation and signs of left ventricular hypertrophy.[9] Aortic regurgitation cardiac MRI
AS Chest X-ray findings associated with aortic stenosis include left ventricular enlargement and calcification of the aortic valve.[10][11] No specific findings on the EKG, the presence of left ventricular hypertrophy (LVH) secondary to chronic pressure overload of the left ventricle due to aortic stenosis is commonly observed.[12] Aortic stenosis MRI Aortic stenosis cardiac catheterization

References

  1. ↑ Mitral regurgitation https://radiopaedia.org/articles/mitral-valve-regurgitation (2016) Accessed on December 13, 2016
  2. ↑ Murphy PJ (1985). "Searching in the dark". Drug Metab. Dispos. 13 (3): 269–71. PMID 2861980.
  3. ↑ O'Keefe, James (2008). The Complete Guide to ECGS. Jones & Bartlett Pub. ISBN 0-7637-6405-1.
  4. ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. 129 (23): 2440–92. doi:10.1161/CIR.0000000000000029. PMID 24589852.
  5. ↑ Mitral regurgitation https://radiopaedia.org/articles/mitral-stenosis Accessed on December 7, 2016
  6. ↑ Velusamy M, Mullens ML, Harrell JE, Talley JD (1995). "The chest x-ray in mitral stenosis". J Ark Med Soc. 91 (12): 604–5. PMID 7790325.
  7. ↑ Maganti K, Rigolin VH, Sarano ME, Bonow RO (2010). "Valvular heart disease: diagnosis and management". Mayo Clin Proc. 85 (5): 483–500. doi:10.4065/mcp.2009.0706. PMC 2861980. PMID 20435842.
  8. ↑ Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD; et al. (1998). "ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease)". J Heart Valve Dis. 7 (6): 672–707. PMID 9870202.
  9. ↑ Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD; et al. (1998). "ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease)". J Heart Valve Dis. 7 (6): 672–707. PMID 9870202.
  10. ↑ Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.
  11. ↑ Robert O. Bonow, Blase A. Carabello, Kanu Chatterjee, Antonio C. Jr de Leon, David P. Faxon, Michael D. Freed, William H. Gaasch, Bruce W. Lytle, Rick A. Nishimura, Patrick T. O'Gara, Robert A. O'Rourke, Catherine M. Otto, Pravin M. Shah & Jack S. Shanewise (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". Journal of the American College of Cardiology. 52 (13): e1–142. doi:10.1016/j.jacc.2008.05.007. PMID 18848134. Unknown parameter |month= ignored (help)
  12. ↑ Markku Kupari, Heikki Turto & Jyri Lommi (2005). "Left ventricular hypertrophy in aortic valve stenosis: preventive or promotive of systolic dysfunction and heart failure?". European heart journal. 26 (17): 1790–1796. doi:10.1093/eurheartj/ehi290. PMID 15860517. Unknown parameter |month= ignored (help)

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