A 16-year-old male presents for a sports participation examination. He has no si

Question

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.

1. Consider how you would diagnose and prescribe treatment for the patient.

2. Select one of the following patient factors: genetics, ethnicity, or behavior. Reflect on how the factor you selected might impact diagnosis and prescription of treatment for the patient in the scenario.

Explanation / Answer

Murmurs can happen for many reasons, such as:

When a valve does not close tightly and blood leaks backward (regurgitation)
When blood flows through a narrowed or stiff heart valve (stenosis)

1. During physical examination when they found cardiac murmer they can go for further investigations like:

Electrocardiogram: During an ECG, sensors (electrodes) that can detect the electrical activity of your heart are attached to your chest and sometimes to your limb.

Echocardiography:Echocardiography (EK-o-kar-de-OG-ra-fee) is a painless test that uses sound waves to create pictures of your heart. It provides your doctor with information about the size and shape of your heart and how well your heart's chambers and valves are working.The test also can find areas of heart muscle that aren't contracting normally due to poor blood flow or injury from a previous heart attack.

Blood Tests:You may have blood tests to check the levels of potassium, magnesium, and other chemicals in your blood that play an important role in your heart's electrical signaling.

Treatment:

if it is due to valve disease surgical intervention is needed like in aortic stenosis -aortic valve replacement in the elderly.if it is due to aortic regurgitation the use of after load-reducing agents such as nifedipine (Procardia), an angiotensin-converting enzyme inhibitor or hydralazine (Apresoline) in asymptomatic patients with moderate to severe aortic regurgitation has been shown to decrease the progression of cardiac enlargement and even postpone the timing of valve replacement.

2.Behaviour had impact on diagnosis and prescription of treatment in this case, advance practice nurse examined abnormal heart murmer but the patient denies cardiovascular symptoms so without patients proper history and consent further investigations cannot be done and cannot find past history of disease. so behaviour of unwillingness to give correct history can lead to fatal result which caused death of the patient.

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