AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentMedium
A 15-year-old male presents for a sports physical. He is asymptomatic, denies any medical problems, and takes no medications. His family history is notable for his paternal uncle who died suddenly at age 30 due to a 'heart problem.' On physical examination, the nurse practitioner notes a loud S4 gallop and a harsh, crescendo-decrescendo systolic murmur heard best at the left sternal border, which increases with standing. What is the most important diagnostic test to order?
- AChest X-ray (CXR)
- BElectrocardiogram (ECG)
- CEchocardiogram
- DExercise stress test
Show answer & explanationAnswer & explanation
Correct answer: C. Echocardiogram
The family history of sudden cardiac death in a young relative, along with the physical exam findings of a loud S4 and a harsh systolic murmur that increases with standing, are highly suggestive of hypertrophic cardiomyopathy (HCM). An echocardiogram is the definitive diagnostic test for HCM, as it directly visualizes the thickened ventricular walls and assesses left ventricular outflow tract obstruction.
Why the other options are wrong
- A. A CXR would likely be normal or show non-specific cardiomegaly and is not diagnostic for HCM.
- B. An ECG might show left ventricular hypertrophy or T-wave inversions, but it is not definitive for HCM and cannot visualize the structural changes.
- D. An exercise stress test evaluates for exercise-induced ischemia or arrhythmias but is not the primary diagnostic tool for the structural diagnosis of HCM.
Hypertrophic Cardiomyopathy (HCM)
A genetic condition causing abnormal thickening of the heart muscle, leading to impaired relaxation and potentially outflow tract obstruction, a common cause of sudden cardiac death in young athletes.
- Family history of sudden cardiac death is a red flag.
- Murmur increases with standing/Valsalva.
- Echocardiogram is the diagnostic gold standard.
Memory trick: Murmur Changes? Echo is Your Answer!