wk5patho - Running head WK5PATHO 1 wk5patho April Matthews...

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April Matthews
Walden University

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Discussion #1
For 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 test
before 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 between S1 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 with
partially 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).