Health Assessment Paper

Health Assessment Paper

Health Assessment Paper 150 150 Peter

Health Assessment Paper

TY is a 67-year-old female patient who presents for follow-up for her hypertension and hyperlipidemia. Her PMH includes a diagnosis of aortic stenosis diagnosed 2 years ago, IBS, and a seizure disorder. Her family history includes her father, who died at age 55 years of a myocardial infarction and her mother, who is deceased, who had hypertension, diabetes, and coronary artery disease. Her social history is positive for smoking 1 PPD for 30 years; she quit 9 years ago. She is negative for alcohol and drug use. She lives in a two-bedroom condominium on one floor.

1. On examination, describe the murmur that you would hear for aortic stenosis.

2. Describe the cause of aortic stenosis. What is the cause for TY?

3. If TY’s past medical history did not include a diagnosis of aortic stenosis as well as cardiac risk factors, what other causes are there for a heart murmur?

4. If TY’s past medical history did not include a diagnosis of aortic stenosis as well as cardiac risk factors, describe a subaortic stenosis.

Sample Paper

  1. On examination, describe the murmur that you would hear for aortic stenosis. 

Midsystolic ejection murmur, diamond-shaped, medium pitched, coarse; extends with audible thrill along the left sternal border (occasionally to the apex) and to the carotid; S1 is often clearest at the apex, and disappears when there is severe stenosis and is frequently succeeded by an ejection click; S2 is missing or soft and may not be separated; S4 is felt; ejection sound attenuated in calcified valves; The more severe the stenosis, the later the murmur reaches its systolic peak. Near the second right intercostal boundary, an ejection sound is heard across the aortic area. Apical thrust is prolonged and shifts down and left in the presence of left ventricular hypertrophy.

2. Describe the cause of aortic stenosis. What is the cause for TY?

The most significant cause of aortic stenosis is the presence of calcium deposits in the arteries, resulting in blockage or narrowing of the aortic valve. A history of hypertension and hyperlipidemia also increases the chances of aortic stenosis. Additionally, Intake of Fatty foods and high cholesterol levels may predispose the patient to increase the accumulation of calcium deposits. Lastly, in the case of TY, smoking is the primary cause of the condition since it increases the formation of plaque in the blood vessels that, in turn, blocks the flow of blood in the valves.

  1. If TY’s past medical history did not include a diagnosis of aortic stenosis and cardiac risk factors, what other causes are there for a heart murmur?

A heart murmur can be caused by high output demands increasing the blood flow speed, for example, pregnancy and fever (Devabhaktuniet al,. 2018). Structural defects, either acquired or congenital, allow blood to flow through the wrong pathways, for instance, ventricular or atrial septal defects. In addition, the condition may also be a result of reduced myocardial contraction strength and severe aortic regurgitation. Finally, a heart murmur can also result from strong left ventricular ejection.

  1. If TY’s past medical history did not include a diagnosis of aortic stenosis as well as cardiac risk factors, describe a subaortic stenosis

The second most prevalent type of left ventricular outflow blockage is subaortic stenosis. It occurs when the left ventricle’s blood flow is impeded (Mulla & Siddiqui, 2018).. This obstruction is located in the heart area beneath the aortic valve. Most patients with subaortic stenosis are asymptomatic. Progression of subaortic stenosis is often very slow, and it can take years before the patient starts having symptoms, but it also gets worse when the patient starts getting older.

Diagnosis

  • It is usually diagnosed by a heart murmur, which is a vital sign of subaortic stenosis. An echocardiogram or heart ultrasound is used to diagnose and monitor the progression of subaortic stenosis. It will show the level and severity of the obstruction, and if the left ventricle is thickened or enlarged.
  • A magnetic resonance imaging (MRI) study or cardiac catheterization will help in confirming the diagnosis and assessing the severity.

Symptoms

  • Subaortic stenosis symptoms vary according to the severity of the obstruction:
  • Dizziness, shortness of breath, or weariness during physical activity
  • Chest pain or loss of consciousness during exercise or exertion

Sudden cardiac death is a complication of severe or untreated subaortic stenosis.

 

References

Devabhaktuni, S. R., Chakfeh, E., Malik, A. O., Pengson, J. A., Rana, J., & Ahsan, C. H. (2018).

Subvalvular aortic stenosis: a review of current literature. Clinical cardiology41(1), 131-136.

https://onlinelibrary.wiley.com/doi/full/10.1002/clc.22775

Mulla, S., & Siddiqui, W. J. (2018). Subaortic stenosis.

https://europepmc.org/article/NBK/nbk526085