What is the management plan for a 24-year-old female (F) patient with a murmur and normal echocardiogram (ECHO) findings, including normal left ventricular (LV) size and function, normal right ventricular (RV) size and function, and no hemodynamically significant valvular heart disease?

From the Guidelines

For a 24-year-old female patient with a murmur and normal echocardiogram findings, the management plan should focus on reassurance and routine follow-up without specific cardiac interventions. The patient can be informed that her murmur represents a benign or physiologic finding, as the comprehensive echocardiogram has ruled out structural heart disease, as indicated by the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association 1. No cardiac medications or activity restrictions are necessary. The patient should continue with regular primary care visits, typically annually, with cardiac auscultation during these routine examinations. If new cardiac symptoms develop such as chest pain, syncope, palpitations, or exercise intolerance, prompt reevaluation would be warranted. The benign nature of this finding is supported by the normal left and right ventricular size and function, absence of valvular disease, and likely represents normal blood flow sounds that can occur in young, healthy individuals with increased cardiac output or thin chest walls. Many physiologic murmurs are flow murmurs that occur during states of high cardiac output, such as during pregnancy, anemia, or in athletic individuals, and do not represent pathology requiring intervention when echocardiogram findings are normal. According to the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease, patients with grade 1 or 2 midsystolic murmurs and no other symptoms or signs of cardiac disease do not require an extensive workup 1. Therefore, the patient can be reassured and discharged with a plan for routine follow-up.

From the Research

Echocardiogram Findings

• The patient's echocardiogram results show normal left ventricular (LV) size and function, with an ejection fraction (EF) of 65-70% (3D calculated EF is 67%) 2.
• Normal diastolic filling parameters and normal right ventricular (RV) size and function are also noted.
• The results indicate no hemodynamically significant valvular heart disease, which is consistent with the absence of symptoms or significant valve disease in patients with murmurs 3, 4.

Management Plan

• Given the normal echocardiogram findings, the management plan for the 24-year-old female patient with a murmur may involve regular follow-up with a cardiologist to monitor for any changes in cardiac function or the development of symptoms 5.
• The patient's lack of symptoms and normal echocardiogram results suggest that no immediate intervention is necessary, but ongoing monitoring is essential to detect any potential changes in cardiac function 6.
• A careful auscultation of the heart prior to the echocardiogram is mandatory and may help to predict the echocardiographic findings and their interpretation in view of the clinical information 6.

Considerations

• The correlation between murmurs by auscultation and severity of heart valve disease by echocardiography is generally poor, particularly for diastolic murmurs 6.
• The patient's age, sex, and race should be considered when defining normal reference values for LV dimension and functional parameters obtained by 3D echocardiography 2.
• The management plan should be individualized based on the patient's specific clinical presentation and echocardiogram results, with consideration of the latest guidelines and research findings 3, 4, 5.