Neisseria meningitidis plated on blood agar

Question.

During a pre anesthetic check up for laparoscopic cholecystectomy; 56 year old man is found to have a systolic murmur. He is asymptomatic and never known about this. ECG is normal sinus rhythm. BP 118/66 mmHg. There are no known medical or surgical conditions or on any regular medication. What is the most appropriate next step?

        1. Urgent consultation with on call cardiology registrar
        2. Cancel the procedure all together
        3. Ask patient to attend A+E
        4. Refer to GP for further investigation
        5. Book urgent outpatient echocardiogram

    Answer.

    5. Book urgent outpatient echocardiogram

     
    Explanation.

    1. Asymptomatic murmur is most likely to be benign
    2. Any signs or symptoms of cardiac decompensation i.e.; exertional dyspnea, chest pain, radiation of murmur, fever or peripheral edema
    3. If suspected endocarditis or MI urgent referral to ED and speak to cardiologist
    4. Choice of investigation for structural heart disease Transthoracic echocardiogram
    5. No indication to cancel procedure at present