A-year-old boy seen in pre-sport screening clinic found to have fixed widely split second heart sound with grade 2 ejection systolic murmur at upper left steal border. ECG was norm... A-year-old boy seen in pre-sport screening clinic found to have fixed widely split second heart sound with grade 2 ejection systolic murmur at upper left steal border. ECG was normal. Blood pressure 110/70 mmHg Heart rate 76/min Respiratory rate 18/min Temperature 36.6 °C Oxygen saturation 95 % Which of the following is the most appropriate next action?
Understand the Problem
The question describes a clinical scenario involving a young boy with specific cardiac findings during a pre-sport screening. It presents several options for the next course of action and asks you to determine the most appropriate one. The key findings are a fixed, widely split S2 heart sound and a grade 2 ejection systolic murmur at the upper left sternal border, in the context of a normal ECG. This clinical picture is highly suggestive of an atrial septal defect (ASD). The question is essentially testing your knowledge of common congenital heart conditions, their presentation, and appropriate management strategies.
Answer
Refer to a cardiologist for an echocardiogram.
The most appropriate next action is to refer the boy to a cardiologist for an echocardiogram. The fixed splitting of the second heart sound and the ejection systolic murmur suggest a possible atrial septal defect or other structural heart abnormality, which requires further evaluation.
Answer for screen readers
The most appropriate next action is to refer the boy to a cardiologist for an echocardiogram. The fixed splitting of the second heart sound and the ejection systolic murmur suggest a possible atrial septal defect or other structural heart abnormality, which requires further evaluation.
More Information
Echocardiography is a non-invasive test that uses sound waves to create a detailed image of the heart's structure and function. It is the primary tool for diagnosing atrial septal defects and other congenital heart conditions.
Tips
It is a common mistake to dismiss heart murmurs in young athletes as benign without proper investigation. While some murmurs are innocent, others can indicate underlying heart conditions that need to be addressed to ensure the athlete's safety. Failure to identify and manage these conditions can lead to serious complications, including sudden cardiac death.
Sources
- What screening should my son have? A murmur was discovered ... - texasheart.org
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