AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentHard
A 15-year-old male presents for a sports physical. He reports no current symptoms but his mother mentions that his older brother died suddenly at age 17 during a basketball game. On cardiac auscultation, a harsh systolic murmur is heard best at the left sternal border that increases with the Valsalva maneuver. Which diagnostic test is most appropriate to evaluate for the suspected condition?
- AElectrocardiogram (ECG)
- BChest X-ray
- CEchocardiogram
- DCardiac stress test
Show answer & explanationAnswer & explanation
Correct answer: C. Echocardiogram
The patient's family history of sudden cardiac death in a young relative, the harsh systolic murmur, and its augmentation with Valsalva maneuver are highly suggestive of Hypertrophic Cardiomyopathy (HCM). An echocardiogram is the definitive diagnostic test for HCM as it directly visualizes ventricular wall thickness, left ventricular outflow tract obstruction, and mitral valve abnormalities.
Why the other options are wrong
- A. ECG can show abnormalities in HCM (e.g., left ventricular hypertrophy), but it is not diagnostic on its own and less sensitive than an echo.
- B. A chest X-ray might show cardiomegaly but cannot diagnose HCM specifically or assess the severity of obstruction.
- D. A cardiac stress test evaluates exercise-induced ischemia or arrhythmias but is not the primary diagnostic tool for the structural changes of HCM.
Hypertrophic Cardiomyopathy (HCM) Diagnosis
Hypertrophic Cardiomyopathy (HCM) is a genetic disorder characterized by unexplained left ventricular hypertrophy. Diagnosis is primarily made by echocardiography, which visualizes the thickened myocardium and assesses outflow tract obstruction.
- Common cause of sudden cardiac death in young athletes.
- Physical exam: harsh systolic murmur that increases with Valsalva.
- Echocardiogram is the gold standard for diagnosis.
Memory trick: HCM: Heart's Hypertrophy Confirmed by Echo.