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. Cardiovascular Alterations
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. Cardiovascular Alterations
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.
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.
** Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Chapter 23, “Structure and Function of the Cardiovascular and Lymphatic Systems” Cardiovascular Alterations
This chapter examines the circulatory system, heart, systemic circulation, and lymphatic system to establish a foundation for normal cardiovascular function. It focuses on the structure and function of various parts of the circulatory system to illustrate normal blood flow.
Chapter 24, “Alterations of Cardiovascular Function”
This chapter presents the pathophysiology, clinical manifestations, evaluation, and treatment of various cardiovascular disorders. It focuses on diseases of the veins and arteries, disorders of the heart wall, heart disease, and shock.
Chapter 25, “Alterations of Cardiovascular Function in Children” Cardiovascular Alterations
This chapter examines cardiovascular disorders that affect children. It distinguishes congenital heart disease from acquired cardiovascular disorders.
** Hammer, G. G. , & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.
Chapter 11, “Cardiovascular Disorders: Vascular Disease”
This chapter begins with an overview of the vascular component of the cardiovascular system and how the cardiovascular system is normally regulated. It then describes three common vascular disorders: atherosclerosis, hypertension, and shock. Cardiovascular Alterations
**American Heart Association. (2012). Retrieved from http://www.heart.org/HEARTORG/
**Million Hearts. (2012). Retrieved from http://millionhearts.hhs.gov/index.html
**National Heart, Lung, and Blood Institute. (2012). Retrieved from http://www.nhlbi.nih.gov/
A large and growing body of literature has focused on the association between “white coat hypertension” (WCH) and the underlying target organ damage. The evidence suggests that WCH is may not an entirely benign phenomenon. However, whether patients with WCH should receive antihypertensive drugs is unresolved. Therefore, we performed a meta-analysis to fully determine the ability of WCH to alter cardiovascular structure and to determine whether patients with WCH could benefit from drug intervention. Medline, EMBASE, and the Cochrane Library were searched from inception through 21 Oct 2019. A total of 25 studies (8,100 individuals) were included. In participants with WCH, values of aortic pulse wave velocity, augmentation index, intima–media thickness, interventricular septum thickness, left ventricular posterior wall thickness, and left ventricular mass index were lower than those with sustained hypertension, but greater than those in the normotensive group. Of note, antihypertensive drug therapy did not reduce the risk of cardiovascular events in patients with WCH. WCH is accompanied by alterations of cardiovascular structure; however, the benefits from antihypertensive therapy are limited Cardiovascular Alterations
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