> I tend to refer a lot of these patients on to a cardiologist if I
> detect an
> Aortic Stenotic murmer , even asymptomatic cases. A colleague
> today says he
> only refers them if they develope angina , syncope or dyspnoea. Am I over
> referring on this or is he under referring?
Aortic stenosis with angina is very worrying and local resources being what
they are I would worry that these patients are getting into the system too
late. My feeling is that your balance is te better one.
Maybe there is a stage inbetween.
Do you have access to echocardiography? If not you should lobby for it. This
investigation will definitively answer the question of the stenotic severity
if it is not just a scerotic murmur in the first place. It is not invasive
and give heaps of other useful information.
I dont have open access echo but I write on a plain xray form why I think it
is necessary and the radiologists find it irresitable. Not had any refused.
I like radiologists.. much underused IMHO
> One more related question. You carry out a routine examination on a
> hypertensive patient who is well controlled on Captopril for
> ages and you
> detect an Aortic Stenotic murmer. What do you do?
Er.. get an echo.
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