Role of endocardial septal ablation in the treatment of hypertrophic obstructive cardiomyopathy

PLEASE RESPONSE TO THE ABOVE THIS POST After examining the patient in the provided scenario, the first thing to determine is why this seemingly healthy 16-year-old has a heart murmur. “Any disease process that creates turbulent flow in the heart or great vessels can cause a murmur” (Hammer & McPhee, 2019, pg. 307). The patient would need further examination. Having the patient change positions and auscultating for the murmur while standing would be a simple way to evaluate if the murmur is significant. “McLaren et al12 reported that the prevalence of physiologic heart murmur in schoolchildren was 65% when they were in a supine position, whereas it was only 15% when they were standing” (Lefort, Cheyssac, Soulé, Poinsot, Vaillant, Nassimi, & Chantepie, 2017, para. 3). The patient would not be cleared to play sports and would possibly be referred to a pediatric cardiologist for further evaluation. It may also be determined that this patient may need an echocardiogram to better evaluate the heart. “Echocardiography is widely available from various sources for providing diagnostic certainty and reducing anxiety” (Sackey, 2016, pg. 446). Treatment for this patient will vary depending on the cause of the murmur. There are multiple genetic conditions that could result in a child developing a heart murmur. “Genetic factors also have been implicated in the incidence of congenital heart disease, although the mechanism of causation is often unknown” (Huether & McCance, 2017, pg. 655). While there are other causes for heart disease in children, most have an underlying genetic cause. Children that have a sibling with congenital heart disease may be at an increased risk of having it themselves. References Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education. Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby. Lefort, B., Cheyssac, E., Soulé, N., Poinsot, J., Vaillant, M.-C., Nassimi, A., & Chantepie, A. (2017). Auscultation While Standing: A Basic and Reliable Method to Rule Out a Pathologic Heart Murmur in Children. Annals of Family Medicine, 15(6), 523–528. Sackey, A. H. (2016). Prevalence and diagnostic accuracy of heart disease in children with asymptomatic murmurs. Cardiology in the Young, 26(3), 446–450. Reply Quote Email Author Message Read Mark as Unread Message Not Flagged Set Flag this one student response Your post very simple and precise yet carries a lot of information. You summarized your post to cover your assessment and diagnosis and treatment plan. I will like to give a little explanation regarding hypertrophic obstructive cardiomyopathy. Hypertrophic obstructive cardiomyopathy is the most common inherited cardiac disorder, and the leading cause of sudden cardiac death among athletes “(Huether & McCance, 2012, p 612). It is the result of the left ventricular outflow tract (LVOT) being obstructed by thickening of the septal wall. This occurs due to stress of the heart due to heart rate or decreased intravascular volume. Dysrhythmias leading to sudden death are major risk factors (p.612). The obstruction of LVOT, caused by systolic anterior motion (SAM) of anterior mitral leaflet with elevated intracavitary LV pressures, can produce disabling symptoms of heart failure and excess cardiovascular mortality (Asku, 2016, p.707) Diagnosis must be made by a cardiology specialist, and include labs, EKG, and chest xray (American Heart Association, 2016). Hypertrophic Obstructive Cardiomyopathy is usually transmitted in an autosomal dominant pattern with variable penetrance. Septal reduction therapy (SRT) is the accepted treatment modality in patients with hypertrophic obstructive cardiomyopathy (HOCM). Myectomy is a well-established, effective surgical technique for drug resistant HOCM patients, and trans coronary alcohol septal ablation (TASA) is an alternative option in patients who refused surgery or high risk for surgery (Asku, 2016). Non-surgical interventions include reduction of stress and alcohol consumption, as well as weight loss (Asku, 2016). Reference. Aksu, T. (2016). Role of endocardial septal ablation in the treatment of hypertrophic obstructive cardiomyopathy. The Anatolian Journal of Cardiology, 16, 707-712. doi:10.14744/anatoljcardiol.2016.7100 American Heart Association. (2016). Prevention and Treatment of Cardiomyopathy. Retrieved from Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby Reply Quote Email Author Select: All None List Actions

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