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 diagnosis and prescription of treatment for the patient in the scenario. By Day 3 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. Patho Discussion One of Week 5 Paper.
According to the provided information, the most likely diagnosis for the patient is mitral valve regurgitation, with likely cause of dilated cardiomyopathy. Mitral valve regurgitation is a condition where the mitral valve of the heart does not close compactly and this allows the blood to flow backward into the heart. Systolic murmurs picked up at the heart’s apex indicate mitral valve disease (Pozzoli et al, 2016). During mitral valve regurgitation, the blood flows back from the left ventricle to the left atrium in ventricular systole and this is what produces the systolic murmurs audible loudest at the heart’s apex. Therefore, a physical examination involving listening to the heart using a heart can be used to diagnose mitral valve regurgitation; sounds of blood leaking backward via the mitral valve (heart murmurs) are produced (Kim et al, 2015).
Possible treatment for the patient includes diuretics, vasodilators, and blood thinners. The diuretics can in preventing fluid overload while vasodilators manage acute hemodynamic decompensation during mitral valve regurgitation. Blood thinners will be important in preventing blood clots and the ensuing heart attack or stroke (Pozzoli et al, 2016). In addition, the patient may be prescribed beta blockers to decrease the heart rate and antiarrhythmics to treat atrial fibrillation allied to mitral valve stenosis. Since the main cause of mitral valve regurgitation in children such as the patient in the case study is rheumatic fever, the patient needs a prescription of antibiotics (Pozzoli et al, 2016).
Impact of Behavior on the Diagnosis and Treatment for the Patient
Behavior factors such as physical activity, adherence to the treatment and nutrition can impact the diagnosis and treatment for the patient. Adequate physical activity can maintain a healthy heart while consuming a diet rich in vegetables, whole grains and fruits, and low fats and sugars can help in maintaining a healthy heart. Adherence to the prescribed treatment will help in the patient’s recovery. After the diagnosis, the patient should avoid physical exercises that can overwhelm the heart (Bonow et al, 2015). Patho Discussion One of Week 5 Paper.
Bonow RO, Nishimura RA, Thompson P & Udelson J. (2015). Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 5: valvular heart disease: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 1(66), 2385-2392.
Kim E, Kim W, Choi E, Cho S, Jang W & Kim Y. (2015). Surgical Management of Mitral Regurgitation in Patients with Marfan Syndrome during Infancy and Early Childhood. Korean J Thorac Cardiovascular Surg. 48(1), 7–12.
Pozzoli A, Bonis M & Alfieri O. (2016). Mitral valve repair. Version 1. F1000Res. 5(1). Patho Discussion One of Week 5 Paper.