AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentHard
A 15-year-old male presents for a sports physical. He denies any medical problems or symptoms. His maternal uncle died suddenly at age 30 due to a cardiac event. On physical examination, a harsh systolic murmur is heard best at the left sternal border and increases with a Valsalva maneuver. Which of the following diagnostic tests should be ordered first?
- AElectrocardiogram (ECG)
- BCardiac MRI
- CEchocardiogram
- DHolter monitor
Show answer & explanationAnswer & explanation
Correct answer: C. Echocardiogram
The patient's family history of sudden cardiac death, combined with a harsh systolic murmur that increases with Valsalva maneuver, is highly suggestive of hypertrophic cardiomyopathy (HCM). An echocardiogram is the most appropriate first diagnostic test to visualize cardiac structure and function, specifically to assess for left ventricular hypertrophy.
Why the other options are wrong
- A. ECG can show left ventricular hypertrophy or conduction abnormalities but is not definitive for HCM and can be normal.
- B. Cardiac MRI is a more advanced imaging technique used for further characterization or if echo is inconclusive, not typically the first-line test.
- D. Holter monitor assesses for arrhythmias, which are a complication of HCM, but does not diagnose the structural heart disease itself.
Hypertrophic Cardiomyopathy (HCM) Diagnosis
Diagnostic steps for identifying a genetic heart condition characterized by abnormal thickening of the heart muscle, particularly the left ventricle.
- Often asymptomatic, but can cause sudden cardiac death.
- Key findings: systolic murmur increasing with Valsalva, family history of sudden death.
- Echocardiogram is the primary diagnostic tool.
Memory trick: HCM: 'H'ear the murmur, 'C'heck the family, 'M'easure with Echo.