Question

A 44 year old male patient comes to the clinic for his routine well visit. He has a history of obesity, hypertension, and migraines. He takes lisinopril for his hypertension. He has not had any complaints. Upon examination, the nurse practitioner hears a sound over the pulmonic area during inspiration and disappears at expiration. The nurse practitioner knows that:

a. This may indicate malformation of his heart
b. This patient should be referred to cardiology
c. This is a benign variant
d. This is a common finding in obese patients

Answer 1

A sound over the pulmonic area during inspiration that disappears on expiration in a patient with obesity and no complaints is likely a benign variant. Additional symptoms or findings would be needed for a cardiologist referral.

Step-by-step explanation:

When a nurse practitioner hears a sound over the pulmonic area during inspiration that disappears at expiration, and given the patient has a history of obesity, hypertension, and migraines on lisinopril, the correct answer is that this is a benign variant. Heart sounds are typically auscultated to assess for abnormal sounds that might indicate heart conditions, but not all sounds indicate pathology. Given that the sound disappears on expiration and the patient has no other complaints, it is likely a benign finding, possibly influenced by the patient's body habitus. An incidental finding on auscultation should be correlated with the patient's overall clinical presentation and other diagnostic findings before making a referral to a cardiologist. Considering the patient's history and current medications such as lisinopril, it is crucial to monitor for any changes or additional symptoms that could indicate a malformation or dysfunction of the heart requiring cardiology referral. However, the scenario presented does not immediately suggest a serious heart condition.