At least once a year, the media report on a seemingly healthy teenage athlete collapsing during a sports game and dying of heart complications. These incidents continue to outline the importance of physical exams and health screenings for teenagers, especially those who play sports. During these health screenings, examiners check for cardiovascular alterations such as heart murmurs because they can be a sign of an underlying heart disorder. Since many heart alterations rarely have symptoms, they are easy to miss if health professionals are not specifically looking for them. Once cardiovascular alterations are identified in patients, it is important to refer them to specialists who can further investigate the cause.
Consider the following scenario:
A 16-year-old male presents for a sports participation examination. He has no significant medical history and no family history suggestive of risk for premature cardiac death. The patient is examined while sitting slightly recumbent on the exam table and the advanced practice nurse appreciates a grade II/VI systolic murmur heard loudest at the apex of the heart. Other physical findings are within normal limits, the patient denies any cardiovascular symptoms, and a neuromuscular examination is within normal limits. He is cleared with no activity restriction. Later in the season he collapses on the field and dies.
To Prepare
• Review the scenario provided, as well as Chapter 25 in the Huether and McCance text. Consider how you would diagnose and prescribe treatment for the patient.
• Select one of the following patient factors: genetics, ethnicity, or behavior. Reflect on how the factor you selected might impact the diagnosis and prescription of treatment for the patient in the scenario.
Post a description of how you would diagnose and prescribe treatment for the patient in the scenario. Then explain how the factor you selected might impact the diagnosis and prescription of treatment for that patient. All references need to be credible, need doi or http, and nothing less than 5 years.
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Diagnosing and prescribing treatment for the patient in the scenario would involve a comprehensive Assessment of the cardiovascular system and consideration of potential underlying heart disorders. Given the presence of a grade II/VI systolic murmur heard loudest at the apex of the heart, it is important to further investigate the cause of the murmur and evaluate the patient for any cardiovascular abnormalities that may have contributed to the collapse on the field.
The initial step in diagnosing the patient would involve obtaining a detailed medical history, including information about any previous episodes of syncope (fainting) or exertional dyspnea (difficulty breathing during exercise). Additionally, a family history of cardiovascular disorders, sudden cardiac death, or any other relevant hereditary conditions should be assessed.
Further diagnostic tests would be necessary to evaluate the patient’s cardiovascular system. These tests may include an electrocardiogram (ECG) to assess the electrical activity of the heart, an echocardiogram to evaluate the structure and function of the heart, and potentially additional imaging studies such as cardiac magnetic resonance imaging (MRI) or computed tomography (CT) scans. These investigations would help identify any underlying structural or functional abnormalities, such as congenital heart defects or cardiomyopathies, that could be contributing to the patient’s symptoms.
In terms of treatment, the patient’s management would depend on the underlying cause of the cardiovascular alteration identified during the diagnostic workup. If a specific heart disorder is diagnosed, treatment options would be tailored to that condition. For instance, in the case of a congenital heart defect, the patient may require surgical intervention or other interventions to correct the abnormality. If a cardiomyopathy is detected, management may involve medication, lifestyle modifications, and regular follow-up to monitor cardiac function.
The patient factor selected for consideration in this scenario is genetics. Genetics can play a significant role in the diagnosis and treatment of cardiovascular disorders. Certain genetic mutations or inherited conditions can increase the risk of developing heart abnormalities, arrhythmias, or other cardiac conditions. Genetic testing may be warranted in cases where there is a suspicion of an underlying genetic component contributing to the patient’s cardiovascular alteration.
Genetic factors can influence the diagnostic approach by guiding the selection of specific tests or screenings to identify potential genetic mutations or inherited conditions. For example, if there is a family history suggestive of a genetic disorder, such as hypertrophic cardiomyopathy, genetic testing can be performed to identify specific gene mutations associated with the condition. This information would help in making an accurate diagnosis and determining the most appropriate treatment plan.
Moreover, knowledge of the patient’s genetic profile can also impact treatment decisions. Understanding the underlying genetic basis of a cardiovascular disorder can aid in tailoring treatment strategies, monitoring disease progression, and providing appropriate counseling and support to the patient and their family members.
In summary, the diagnosis and treatment of the patient in the scenario would involve a comprehensive Assessment of the cardiovascular system, including a detailed medical history, physical examination, and appropriate diagnostic tests. The patient factor of genetics can impact the diagnostic process by guiding the selection of genetic testing and influencing treatment decisions based on the identified genetic mutations or inherited conditions. Understanding the genetic factors involved in cardiovascular disorders is crucial for accurate diagnosis, appropriate management, and proactive preventive measures for patients at risk.
