4 minutes ago nicole wilcox  Main Post Week 4- Nicole Wilcox COLLAPSE Top of Form A heart murmur is an extra sound the heart makes when blood is flowing through the heart (National Heart, Lung, Blood Institute [NHLBI], n.d.) Some murmurs are innocent and some can be related to a heart defect (NHLBI, n.d.). Heart murmurs are diagnosis by grades (U.S. National Library of Medicine, 2019). The grades are from 1-6 1-6 being the lowest sound heard and 6-6 being the loudest hear (NHLBI, 2019). In the scenario presented the NP diagnosed a grade 2 heart murmur. Due to the grading and the presents of no other abnormal findings there would be no need for further investigation. It is vital for the NP to evaluate the family history and any signs and symptoms presented that would indicate further work is necessary (Healthy Children, 2015).  History of check pain, dizziness, fainting or shortness of breath would indicate abnormal finding (Healthy Children, 2015).  An innocent heart murmur would still need to be continued to be monitored annually to make sure it does not change. For heart murmurs grade three and greater the proper treatment would be to refer to a pediatric cardiologist (Ritz, 2017). Heart murmurs can be related to congenital heart defects (Huether & McCance, 2017). Heart murmurs can be related to aortic septal defects (ASD) which are most common (Huether & McCance, 2017). Heart Murmurs can also be seen with valve disorders (Ritz, 2017). When a grade 3 or high heart murmur is found performing other tests will become necessary such as electrocardiogram, echocardiogram (Cardio Smart, 2012). A cardiac catheterization or surgery may also need to be performed to correct the defect (Cardio Smart, 2012). References Cardio Smart American College of Cardiology. (2012). Heart murmur topic overview. Retrieved from: https://www.cardiosmart.org/Healthwise/zx14/63/zx1463 Healthy Children. (2015). Sudden cardiac death. What is it? Retrieved from: https://www.healthychildren.org/English/health-issues/injuries-emergencies/sports-injuries/Pages/Sudden-Cardiac-Death.aspx Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby National Heart, Blood, Lung Institute [Nhlbi]. (n.d.). Heart murmur overview. Retrieved from: https://www.nhlbi.nih.gov/health-topics/heart-murmur Ritz, S.B. (2017). Heart murmurs. What are heart murmurs? Retrieved from: https://kidshealth.org/en/parents/murmurs.html?WT.ac=p-ra#catbody-basics REPLYQUOTEEMAIL AUTHOR Bottom of Form 3 hours ago Tiffany Jones  Week 5 Main Post #1 COLLAPSE Top of Form Week 5 Main post #1 Murmurs can be challenging to diagnose in adults, as well as in children unless they are easily heard. “Although most are not pathologic, a murmur may be the sole manifestation of serious heart disease” (Frank, Jennifer, & Jacobe, Kathyrn, 2011). Since murmurs may be the only symptom pointing to serious heart complications, it is essential to follow up and have further testing .

1. 4 minutes ago
nicole wilcox
Main Post Week 4- Nicole Wilcox
COLLAPSE
Top of Form
A heart murmur is an extra sound the heart makes when blood is
flowing through the heart (National Heart, Lung, Blood Institute
[NHLBI], n.d.) Some murmurs are innocent and some can be
related to a heart defect (NHLBI, n.d.). Heart murmurs are
diagnosis by grades (U.S. National Library of Medicine, 2019).
The grades are from 1-6 1-6 being the lowest sound heard and
6-6 being the loudest hear (NHLBI, 2019).
In the scenario presented the NP diagnosed a grade 2 heart
murmur. Due to the grading and the presents of no other
abnormal findings there would be no need for further
investigation. It is vital for the NP to evaluate the family
history and any signs and symptoms presented that would
indicate further work is necessary (Healthy Children, 2015).
History of check pain, dizziness, fainting or shortness of breath
would indicate abnormal finding (Healthy Children, 2015). An
innocent heart murmur would still need to be continued to be
monitored annually to make sure it does not change.
For heart murmurs grade three and greater the proper treatment
would be to refer to a pediatric cardiologist (Ritz, 2017). Heart
murmurs can be related to congenital heart defects (Huether &
McCance, 2017). Heart murmurs can be related to aortic septal
defects (ASD) which are most common (Huether & McCance,
2017). Heart Murmurs can also be seen with valve disorders
(Ritz, 2017). When a grade 3 or high heart murmur is found
performing other tests will become necessary such as
electrocardiogram, echocardiogram (Cardio Smart, 2012). A
cardiac catheterization or surgery may also need to be
performed to correct the defect (Cardio Smart, 2012).

2. References
Cardio Smart American College of Cardiology. (2012). Heart
murmur topic overview. Retrieved from:
https://www.cardiosmart.org/Healthwise/zx14/63/zx1463
Healthy Children. (2015). Sudden cardiac death. What is it?
Retrieved from:
https://www.healthychildren.org/English/health-issues/injuries-
emergencies/sports-injuries/Pages/Sudden-Cardiac-Death.aspx
Huether, S. E., & McCance, K. L. (2017). Understanding
pathophysiology (6th ed.). St. Louis, MO: Mosby
National Heart, Blood, Lung Institute [Nhlbi]. (n.d.). Heart
murmur overview. Retrieved from:
https://www.nhlbi.nih.gov/health-topics/heart-murmur
Ritz, S.B. (2017). Heart murmurs. What are heart murmurs?
Retrieved from:
https://kidshealth.org/en/parents/murmurs.html?WT.ac=p-
ra#catbody-basics
REPLYQUOTEEMAIL AUTHOR
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3 hours ago
Tiffany Jones
Week 5 Main Post #1
COLLAPSE
Top of Form
Week 5 Main post #1
Murmurs can be challenging to diagnose in adults, as well as in
children unless they are easily heard. “Although most are not
pathologic, a murmur may be the sole manifestation of serious
heart disease” (Frank, Jennifer, & Jacobe, Kathyrn, 2011). Since
murmurs may be the only symptom pointing to serious heart
complications, it is essential to follow up and have further
testing done when one is first detected.

3. In this scenario, a grade II/VI systolic murmur is detected in a
16 yr old male athlete. “This means the murmur is grade 2 on a
scale of 1 to 6 (“Medline Plus, 2019). The patient is in a
slightly recumbent position, which can also affect the way the
murmur sounds. There are several things to consider when a
murmur is detected for the first time, especially in an
adolescent. Does the murmur occur during systolic or diastolic
contraction? Does the murmur change when the patient moves?
Can it be heard in other areas, such as the neck, back or the
chest? Also, where is it the loudest? Depending on the answer
to these questions, the patient might need to be referred to a
cardiologist for further testing.
It also states in the scenario that there is no family history of
premature cardiac death, but it does not state that there is no
cardiac history in the family. The patient and the parents would
need to be questioned further to see what the extent is, if any,
of any cardiac disease. They also need to be questioned to see if
there is a history of congenital heart disease, maternal diabetes,
exposure to alcohol or drugs while in utero, any genetic
disorders, and history of Kawasaki disease or rheumatic fever.
If the patient or family member has any one of these or a
combination of them, it is cause for alarm, and the patient needs
to be screened for a more serious heart condition.
Behavior can also play a part in heart murmurs in adolescents.
The patient would need to be examined while doing physical
exercise to see if he has any breathing difficulties and to see
how his heart acts under physical exertion and stress. If the
patient becomes short of breath or the murmur increases to a 3
or above, these are big red flags and could indicate an
underlying cardiac condition. These are not conclusive that
there is more going on, it could be that the child is overweight
or out of shape, but it is better to have the child examined by a
cardiologist to make sure there is nothing wrong with his heart.
The cardiologist will most likely order a chest x-ray and an
echocardiogram. “Echocardiogram (also called "echo" or
cardiac ultrasound): sound waves create an image of the heart”

4. (Children's Hospital of Philadelphia, 2018). The Echo will be
the most conclusive test to determine if there are any
abnormalities with his heart. If I were the provider for an
adolescent who presented with a murmur for the first time, I
would do a thorough examination, including all of the questions
and tests described above. If anything during these were
abnormal, I would refer him to a pediatric cardiologist to
determine if there is anything wrong with his heart.
References
Children’s Hospital of Philadelphia (2018). Heart murmur in
children.
https://www.chop.edu/conditions-diseases/heart-murmur
Frank, Jennifer, & Jacobe, Kathyrn (2011). Evaluation and
management of heart murmurs in children. American family
physician. https://www.aafp.org/afp/2011/1001/p793.html
Medline Plus (2019) Heart murmurs
https://medlineplus.gov/ency/article/003266.htm.
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