Cardiovascular Alterations
Introduction
A cardiac murmur is the irregular sound heard during cardiac Beats, also characterized as a
whispering or a swelling sound caused by stormy blood flow through the heart valves (National Heart,
Lung, Blood Institute, 2016). Children usually suffer from whispering because of a heart defect or an
irregular valve (National Heart, Lung and the Blood Institute, 2016). The main cause in adults is valve
lesions (Hammer & McPhee, 2014). Blood flow is the result either of an aortic valve's narrowing, or an
inability, which may occur from a heart condition (Hammer & McPhee, 2014). (Hammer & McPhee,
2014). Murmurs may also be caused by conditions such as exercise, pregnancy and anemia, which
temporarily increase blood circulation, according to the National Heart, Lung, and Blood Institute (2016).
Diagnosing and Treating the Patient in this Scenario
In this scenario, the 16-year-old patient initially presented at a sports physical with no significant
medical history and no family history of cardiovascular disorders. However, upon physical examination
the nurse hears a grade II systolic heart murmur which can be auscultated loudest at the apex of the
heart. Murmurs are graded from 1-6, with 1 being very faint and 6 being the loudest (American Heart
Association, 2016). This patient has a grade 2 murmur, and according to the American Heart Association,
quiet murmurs such as grade 1-2 are more likely to be benign. To diagnose this patient, the provider
would need to listen to the sound, location, and duration of the murmur and take the patient’s medical
and family history into consideration to determine if the murmur is harmless, or the result of a more
serious condition (National Heart, Lung, and Blood Institute, 2016). A CT scan, EKG, echocardiogram, or
chest x-ray may be ordered to discover the cause of the murmur (American Heart Association,
2016).Since this particular patient is an athlete, a stress test should be ordered to demonstrate how the
heart performs during physical activity or exercise (National Heart, Lung, and Blood Institute, 2016). The
treatment of a murmur depends on the root cause, and can range from medications to surgery to
cardiac catheterization (National Heart, Lung, and Blood Institute, 2016).
Impact of Behavior on Diagnosis and Treatment
This patient is a 16-year-old male who plays sports, so behavior is a significant factor that affects
his diagnosis and treatment. Although he has no past or family history of heart problems and no physical
symptoms suggesting a cardiovascular issue, when the nurse hears a murmur, further investigation
should be done to determine the cause, especially when we know that this patient will be engaging in
strenuous physical activities that put stress on his heart. The patient should be referred to a pediatric
cardiologist for further testing. A stress test will be a great way to see how his heart reacts to the
exercise he will be doing playing sports. Echocardiogram should be performed to check the structure
and function of his heart. Valvular aortic stenosis (VAS) is one example of a serious condition that needs
to be ruled out for this patient, because it is a form of congenital heart disease where physical activities
should be restricted due to significant risk of “sudden episodes of myocardial ischemia or low cardiac
output that, on rare occasions, can result in sudden death in late childhood or adolescence” (Huether&
McCance, 2017, p. 657). Before the patient can be cleared to play sports, the murmur should be
investigated and cardiovascular alterations such as VAS should be ruled out.
References
American Heart Association. (2016). Heart murmurs and valve disease. Retrieved from
http://www.heart.org/HEARTORG/Conditions/More/HeartValveProblemsandDisease/Heart-
Murmurs-and-Valve-Disease_UCM_450616_Article.jsp#.WcmDGXaGPIU
Hammer, G.G., & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine (7th
ed.). New York, NY: McGraw Hill Education.
Huether, S.E., & McCance, K.L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
National Heart, Lung, and Blood Institute. (2016). Heart murmur. Retrieved from
https://www.nhlbi.nih.gov/health/health-topics/topics/heartmurmur
