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Running head: WK5PATHO1wk5pathoApril MatthewsWalden University
WK5PATHO2wk5pathoDiscussion #1For this case scenario of a 16-year-old male with a grade II/VI systolic murmur, the first thing I would do as a practitioner is to order an EKG, Echocardiogram, and a treadmill stress testbefore clearing him to play sports. On the EKG, I would look for prolonged Q-T intervals, and on the Echo, I would be looking for regurgitation. The treadmill stress test could be used to identify activity tolerance. In addition to his physical assessment I would get a detailed family history not just cardiac. In the family history, I would be looking for inherited (genetic) connective tissue disorders which a family member night not find significant when speaking about the heart.“Systolic murmurs involve stenosis of the aortic or pulmonary valves or regurgitation of the mitral and tricuspid valves and occur betweenS1 and S2” (Durkin, 2013, para. 4).It is possible the patient has significant mitral regurgitation. “Mitral regurgitation permits backflow of blood from the left ventricle into the left atrium during ventricular systole, producing a holosystolic murmur” (Huether & McCance, 2017, p. 627), which lead to mitral valve prolapse syndrome. With mitral valve prolapse syndrome a midsystolic click can be heard on auscultation, in a healthy patient.The patient could also suffer from congenital aortic stenosis which develops before the age of 30. Congenital aortic stenosis causes the valve to be “unicuspid, bicuspid or tricuspid withpartially fused leaflets” (Hammer & McPhee, 2014, p. 274). This also causes a midsystolic murmur.“The syndrome associated with mid-systolic click and late systolic murmur or the ballooning posterior mitral leaflet syndrome has been gaining increasing recognition over the past ten years after Barlow's initial description. That sudden death and a familial occurrence can be related to this syndrome has been clearly demonstrated. The use of propranolol has been suggested for this syndrome for its theoretical ability to decrease the systolic stress on the ballooning posterior leaflet, its antiarrhythmic effects, and its ability to shorten the Q-Tc interval.” (Shappell, Marshall, Brown, & Bruce, 1993).