The cardio exam - MVP or regurg

[PAwannabee]

Hi everyone... I'm going to throw this question/concern out there and hopefully someone who works in cardiology can answer this for me...

 

So I'm a PA student, 2nd semester in. We had our cardio block about a month ago. From what I understand, it's pretty basic and pretty important that 1)You auscultate the heart on the skin and not through the gown, and 2)If you are listening for mitral valve issues, you listen in the mitral area - ie the left 5th intercostal, midclavicular line.

 

I went to the cardiologist today (abnormal EKG in PCP office, inverted Ts in right side leads, referral) - is there any good reason(s) why he ...

1) would listen to my heart through the gown?

2)Listen in my aortic and pulmonic areas but be referencing my "murmer" he "heard" that is "probably mitral regurg or prolapse" (instead of listening in the left mid clavicular 5th intercostal)?

 

He did/said other things that I thought were questionable, and had really bad

"bedside"(office) manner and was pretty dismissive, but I am really trying not to jump the gun and am trying to give him the benefit of the doubt. Please tell me, if you know, did he do as crappy of an exam as it seems? Is what I am learning in school not really true, that you -have- to auscultate on the skin and not through a gown, and that if you are listening for the mitral valve you need to listen in the proper place? I feel really full of "judgement" and am kind of angry because I feel like he was in a hurry and not really doing his job. But I am wondering if this is commonplace, for them to take (seemingly terrible) shortcuts like this? His exam would have probably been an "auto-fail" in one of our OSCEs.

 

THANKS in advance!

[sacer83]

Truth: he is a practicing provider and, right or wrong, he gets to examine you the way he wants. It sounds like his exam was sub-par, but there may be a rhyme and reason to why he does it that way. Perhaps he heard a murmur that was NOT emphasized at the aortic and pulmonic areas so he simply inferred that you have a mitral valve murmur of some kind that does not appear to be pathologic (or is at the very least asymptomatic). Maybe that's good enough for him (I would not be ok with it personally). The truth is that he gets to practice the way he wants and that he is likely skipping a few of the other steps because he knows a lot more about hearts than most of us - again, right or wrong.

 

What do you mean by "right side leads?" Do you mean V1? Or did your PCP set up all the V leads on your right chest?

 

Perhaps you should ask him if he has any pearls for you about doing a "thorough" cardiac exam... Open a dialogue and approach it from a "curious student" perspective.

 

Andrew