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Cardiovascular Alteraons
Introducon
A cardiac murmur is the irregular sound heard during cardiac Beats, also characterized as a
whispering or a swelling sound caused by stormy blood ow through the heart valves (Naonal Heart,
Lung, Blood Instute, 2016). Children usually su(er from whispering because of a heart defect or an
irregular valve (Naonal Heart, Lung and the Blood Instute, 2016). The main cause in adults is valve
lesions (Hammer & McPhee, 2014). Blood ow is the result either of an aorc valve's narrowing, or an
inability, which may occur from a heart condion (Hammer & McPhee, 2014). (Hammer & McPhee,
2014). Murmurs may also be caused by condions such as exercise, pregnancy and anemia, which
temporarily increase blood circulaon, according to the Naonal Heart, Lung, and Blood Instute (2016).
Diagnosing and Treang the Paent in this Scenario
In this scenario, the 16-year-old paent inially presented at a sports physical with no signi2cant
medical history and no family history of cardiovascular disorders. However, upon physical examinaon
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
Associaon, 2016). This paent has a grade 2 murmur, and according to the American Heart Associaon,
quiet murmurs such as grade 1-2 are more likely to be benign. To diagnose this paent, the provider
would need to listen to the sound, locaon, and duraon of the murmur and take the paent’s medical
and family history into consideraon to determine if the murmur is harmless, or the result of a more
serious condion (Naonal Heart, Lung, and Blood Instute, 2016). A CT scan, EKG, echocardiogram, or
chest x-ray may be ordered to discover the cause of the murmur (American Heart Associaon,
2016).Since this parcular paent is an athlete, a stress test should be ordered to demonstrate how the
heart performs during physical acvity or exercise (Naonal Heart, Lung, and Blood Instute, 2016). The
treatment of a murmur depends on the root cause, and can range from medicaons to surgery to
cardiac catheterizaon (Naonal Heart, Lung, and Blood Instute, 2016).
Impact of Behavior on Diagnosis and Treatment
This paent is a 16-year-old male who plays sports, so behavior is a signi2cant factor that a(ects
his diagnosis and treatment. Although he has no past or family history of heart problems and no physical
symptoms suggesng a cardiovascular issue, when the nurse hears a murmur, further invesgaon
should be done to determine the cause, especially when we know that this paent will be engaging in
strenuous physical acvies that put stress on his heart. The paent should be referred to a pediatric
cardiologist for further tesng. 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 funcon of his heart. Valvular aorc stenosis (VAS) is one example of a serious condion that needs
to be ruled out for this paent, because it is a form of congenital heart disease where physical acvies
should be restricted due to signi2cant 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 paent can be cleared to play sports, the murmur should be
invesgated and cardiovascular alteraons such as VAS should be ruled out.
References
American Heart Associaon. (2016). Heart murmurs and valve disease. Retrieved from
h@p://www.heart.org/HEARTORG/Condions/More/HeartValveProblemsandDisease/Heart-
Murmurs-and-Valve-Disease_UCM_450616_Arcle.jsp#.WcmDGXaGPIU
Hammer, G.G., & McPhee, S. (2014). Pathophysiology of disease: An introducon to clinical medicine (7
th
ed.). New York, NY: McGraw Hill Educaon.
Huether, S.E., & McCance, K.L. (2017). Understanding pathophysiology (6
th
ed.). St. Louis, MO: Mosby.
Naonal Heart, Lung, and Blood Instute. (2016). Heart murmur. Retrieved from
h@ps://www.nhlbi.nih.gov/health/health-topics/topics/heartmurmur
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