(rainbow trout pictured left)
Today we saw a case of severe aortic stenosis (valve area 0.6 cm).
We have discussed AS in detail before, and you can check out this link for more information on the physical exam.
Can you detect moderate to severe AS at the bedside? Absolutely. Some smart people from Toronto came up with a very helpful clinical prediction rule. The published paper from JGIM is at this link.
This is how it works:
- If there is no murmur over the right clavicle, moderate to severe AS is essentially ruled out.
- If there is a murmur radiating over the right clavicle with 0-2 associated findings, then the Likelihood Ratio for moderate to severe AS is 1.8, and in this study reflected about a 20% chance.
- If there is a murmur radiating to the right carotid with 3-4 associated findings, then moderate to severe AS is essentially ruled in (Likelihood ratio of 40)
So what are the "Associated Findings"?
- Reduced S2
- Reduced carotid volume
- Slow carotid upstroke
- Murmur loudest in the 2nd right intercostal space
Why the trout?
ReplyDeleteI was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
ReplyDeleteliver already present. I started on antiviral medications which
reduced the viral load initially. After a couple of years the virus
became resistant. I started on HEPATITIS B Herbal treatment from
ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
treatment totally reversed the virus. I did another blood test after
the 6 months long treatment and tested negative to the virus. Amazing
treatment! This treatment is a breakthrough for all HBV carriers.
I really want to thank Dr Emu for saving my marriage. My wife really treated me badly and left home for almost 3 month this got me sick and confused. Then I told my friend about how my wife has changed towards me. Then she told me to contact Dr Emu that he will help me bring back my wife and change her back to a good woman. I never believed in all this but I gave it a try. Dr Emu casted a spell of return of love on her, and my wife came back home for forgiveness and today we are happy again. If you are going through any relationship stress or you want back your Ex or Divorce husband you can contact his whatsapp +2347012841542 or email emutemple@gmail.com website: Https://emutemple.wordpress.com/
ReplyDelete