Mind the gap: missed valve disease diagnosis

Mind the gap: missed valve disease diagnosis

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The stethoscope is the image of a doctor. Each affected person expects their physician to pay attention rigorously to their coronary heart and believes that listening with a stethoscope will establish the presence of coronary heart illness. Sadly, our affected person’s belief on this a part of the bodily examination is misplaced. There isn’t a doubt that René Laennec’s invention of the stethoscope over 200 years in the past reworked medical prognosis, and this system stays helpful for amplifying inner noises from a number of completely different organs in well being and illness. Nonetheless, the traits of an audible murmur should not dependable for prognosis, regardless of the long-standing fascination with cardiac auscultation and valvular coronary heart illness as expressed so eloquently by George Eliot in Middlemarch, ‘He was not a lot acquainted with valves of any type, however he knew that valvae had been folding-doors, and thru this crevice got here a sudden gentle startling him along with his first vivid notion of the finely adjusted mechanisms within the human body’.1

Most coronary heart murmurs are benign, as a result of regular blood circulation patterns or related to transient will increase in cardiac output as a result of being pregnant, anaemia, fever or different causes. Nonetheless, some murmurs do point out critical underlying coronary heart illness, and distinguishing a benign from malignant murmur, and even listening to the murmur in any respect, shouldn’t be straightforward. Analysis of coronary heart valve illness is most essential when cardiac signs are current. Sadly, signs as a result of valve illness are non-specific with many sufferers attributing exertional dyspnoea, dizziness, chest discomfort or …

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