transient cardiac murmur post-op?

[amestramgram]

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Hi, has anyone heard a murmur in a post-op patient (for TAH-BSO), only to have it go away post-op day 2? What did you do about the murmur?

thanks for your help

 

[gmsquid]

If the murmur was a II/VI systolic murmur heard at the upper sternal border its probably a flow murmur. Given the fact that patients are often fluid overloaded post op it wouldn't be out of this world.

 

[Dirt]

Yeah I would say that anything other than crescendo/decrescendo systolic or anything greater than II/IV would warrant an echo.

 

[jdh71]

Remember your clinical context. New, clinically relevant murmurs do not show up out of the blue without associated signs and symptoms (ie. shortness of breath, rales, increased lower extremity edema, chest pain, etc.)

Increased stress will increase things like contractility, and having a few organs that mother nature put in one spot removed is enough by itself to increase the dynamic properties of the heart. Next time you're back from a jog, slap a scope on your chest. Tell me what you hear.

 

[vicinihil]

ear wax? jk. I agree with above posters. Look for evidence of heart failure or cardiogenic shock. If in doubt, an Echo won't hurt to verify but definitely put it in clinical context.

 

[jdh71]

ear wax? jk. I agree with above posters. Look for evidence of heart failure or cardiogenic shock. If in doubt, an Echo won't hurt to verify but definitely put it in clinical context.

We do too many unnecessary echos. "Just looking" without a clinical reason to look is weak medicine, just a friendly fyi. 🙂

 

[km11]

Most likely flow murmur from the fluid shifts intraoperative and postoperatively.

 

[OveractiveBrain]

Any Systolic Murmur that is Grade 2 or less is termed "innocent murmuer." Innocent because its benign and needs to evaluation.

Any Diastolic Murmur of any grade or a Grade 3> Systolic is pathologic and needs evaluation.

We do not do "too many echoes." An echocardiogram is a sonogram. The radiation dose is 0, the discomfort to the patient is 0 (particularly in this patient who has probably had 14 sonograms by now anyway). It may increase the cost slightly, but an echo is an easy, safe, test that gives alot of information.

I agree with whats been said already. Fluid overload, recent anemia from pregnancy, even cardiomyopathy of pregnancy can produce a murmur. You note it, say its there, then, if it goes away, poof, no worry.

I presume you are concerned about a previously undiagnosed PFO or VSD. Some hole in this woman's heart that was insignificant thus far, but now, under stress, had been elucidated. You dont want here throwing a venous clot to her brain, but at the same time, the chances that you found a previously asymptomatic and undetected murmur by chance is unlikely, especially if it went away so rapidly and was in the benign criteria.