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.
Cardiovascular Alterations
The patient has no significant medical history, but on the vital signs for cardiovascular problems is grade II and VI systolic murmur. The condition shows that there is a heart problem that finally caused the death of the 16-year old male athlete. Grade II and VI systolic murmur shows the possibility of mitral regurgitation. In the case of mitral regurgitation, the blood does not flow freely but it flows backward due to dysfunction of the heart (Mayo Clinic, 2019). The poor flow of blood in the heart causes the systolic murmur. The condition is clearly noted at the apex of the heart during an examination (Kron et al., 2017). The murmurs point towards an underlying heart problem that should be examined further to prevent death. The patient could also be experiencing dilated cardiomyopathy. The condition reduces the ability of the heart to pump blood due to enlarged and weakened left ventricle (Kron et al., 2017). Dilated cardiomyopathy could be due to underlying coronary heart disease and viral infections that affect heart muscles.
The treatment for mitral regurgitation depends on the severity of the condition. The focus of a nurse is to provide treatment that will reduce the severity of symptoms and improving the functionality of the heart. One of the treatment options is heart surgery to repair or replace the mitral valve (Mayo Clinic, 2019). The healthcare providers can carry out surgery which will be used to prevent heart complications and improve the functionality of the heart. It is also recommended to use various medications to treat the symptoms (Nickenig et al., 2016). For example, diuretics are used to relieve accumulation of blood in the legs and lungs which is a sign of mitral regurgitation. Another option is blood thinners which eliminate possibility of clotting to enhance proper flow of blood. High-pressure medication is also necessary since hypertension can worsen mitral regurgitation (Nickenig et al., 2016). A patient can also be required to make lifestyle changes such as smoking cessation and reducing salt intake. The decision on the treatment option to be used depends on the severity of the condition, health of the patient and further checks to reveal the extent of the valve dysfunction.
Genetics is a patient factor that causes mitral regurgitation. A person is born with the genetic risk of developing mitral regurgitation (Geis et al., 2017). For example, systolic murmur is a condition which is as a result of genetic mutation. The conditions results into poor development of the heart muscles thus causing poor functionality of the valves (Mayo Clinic, 2019). The heart defect causes the blood-pumping organ to close loosely thus causing regurgitation. Although the family has no history of a heart problem, it is important to carry out an extensive review since the problem may be presented in another family member who has not realized yet. Genetic defects are associated with the condition of regurgitation although the actual cause of the disease is not known.
Conclusion
Cardiovascular alterations may be present without any prominent signs and symptoms. The present of systolic murmur should be the foundation of a further investigation on the severity of the condition. Once mitral regurgitation has been established it is important to weigh the option for the best treatment method. They include surgery or medication to suppress the symptoms. The condition is fatal and thus it is important to start medication immediately to suppress the condition before it gets severe.
References
Geis, N., Raake, P., Lewening, M., Mereles, D., Chorianopoulos, E., Frankenstein, L., … & Pleger, S. T. (2018). Percutaneous repair of mitral valve regurgitation in patients with severe heart failure: comparison with optimal medical treatment. Acta Cardiologica, 73(4), 378-386. https://doi.org/10.1080/00015385.2017.1401275
Kron, I. L., LaPar, D. J., Acker, M. A., Adams, D. H., Ailawadi, G., Bolling, S. F., … & Parides, M. K. (2017). 2016 update to The American Association for Thoracic Surgery consensus guidelines: Ischemic mitral valve regurgitation. The Journal of Thoracic and Cardiovascular Surgery, 153(5), 1076-1079. DOI: https://doi.org/10.1016/j.jtcvs.2016.11.068
Mayo Clinic. (2019). Heart Murmurs. Retrieved from https://www.mayoclinic.org/diseases- conditions/heart-murmurs/symptoms-causes/syc-20373171
Nickenig, G., Schueler, R., Dager, A., Clark, P. M., Abizaid, A., Siminiak, T., … & Hammerstingl, C. (2016). Treatment of chronic functional mitral valve regurgitation with a percutaneous annuloplasty system. Journal of the American College of Cardiology, 67(25), 2927-2936. DOI: 10.1016/j.jacc.2016.03.591
