A 40-year-old man presents to the Emergency Department after fainting while exercising. He reports past episodes of chest pain, which have occurred both at rest and with exercise.... A 40-year-old man presents to the Emergency Department after fainting while exercising. He reports past episodes of chest pain, which have occurred both at rest and with exercise. On examination of the chest there is I/IV systolic ejection murmur heard at the left sternal border, which does not radiate. The intensity of the murmur increases when the patient bears down or stands up. The lung fields are clear. What is the next best step in management?
Understand the Problem
The question presents a clinical scenario involving a 40-year-old man with chest pain and other symptoms, followed by a query about the diagnosis or next steps in management. The key concepts include clinical examination findings, symptoms, and possible conditions related to heart murmurs.
Answer
Perform an echocardiogram.
The next best step in management is to perform an echocardiogram.
Answer for screen readers
The next best step in management is to perform an echocardiogram.
More Information
The symptoms and exam findings are suggestive of Hypertrophic Obstructive Cardiomyopathy (HOCM), and an echocardiogram is essential to confirm this diagnosis by showing asymmetric septal hypertrophy.
Tips
A common mistake is to assume this is aortic stenosis, but the murmur in HOCM increases with Valsalva or standing.
Sources
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