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Posted: January 31st, 2023
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.
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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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Based on the scenario provided, the patient is a 16-year-old male who presents for a sports participation examination. During the examination, a grade II/VI systolic murmur is appreciated, which is heard loudest at the apex of the heart. The patient has no significant medical history, no family history suggestive of risk for premature cardiac death, and denies any cardiovascular symptoms. Other physical findings are within normal limits, and a neuromuscular examination is also within normal limits. The patient is cleared with no activity restriction. However, later in the season, he collapses on the field and dies.
Given the presentation of a grade II/VI systolic murmur, it is important to further investigate the underlying cause. The first step would be to refer the patient to a cardiovascular specialist for a thorough evaluation. The specialist may perform additional diagnostic tests to identify the specific cardiovascular alteration and its severity. These tests may include an echocardiogram, which can provide detailed images of the heart and help assess its structure and function. Other tests such as an electrocardiogram (ECG) and exercise stress test may also be considered to evaluate the patient's heart rhythm and response to physical activity.
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Based on the findings from the diagnostic tests, the specialist can make a definitive diagnosis and recommend an appropriate treatment plan. Treatment options will depend on the specific cardiovascular alteration identified. In some cases, lifestyle modifications and medications may be sufficient to manage the condition. However, in more severe cases, surgical interventions such as valve repair or replacement, or other corrective procedures may be necessary.
Regarding the impact of the selected patient factor, which is genetics, on the diagnosis and prescription of treatment, it plays a significant role. Genetic factors can predispose individuals to certain cardiovascular disorders, including structural abnormalities of the heart or inherited arrhythmias. Therefore, when evaluating a patient with a murmur and considering the risk of sudden cardiac death, it is crucial to consider the potential genetic factors associated with these conditions.
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Genetic testing may be recommended to identify any underlying genetic abnormalities that contribute to the cardiovascular alteration. This information can help guide the diagnosis and treatment plan. Additionally, if a genetic mutation is identified, it may have implications for the patient's family members who may also be at risk. Genetic counseling can be offered to provide information about the inheritance pattern, screening recommendations, and potential preventive measures for at-risk family members.
In summary, the patient in the scenario with a grade II/VI systolic murmur should be referred to a cardiovascular specialist for further evaluation. Diagnostic tests, such as an echocardiogram and possibly genetic testing, should be performed to identify the underlying cardiovascular alteration. Treatment options will depend on the specific diagnosis, ranging from lifestyle modifications and medications to surgical interventions if necessary. The impact of genetics on the diagnosis and treatment plan highlights the importance of considering genetic factors in the evaluation of cardiovascular disorders, as they can influence the underlying cause and potential management strategies.
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