Question

The nurse is auscultating for extraneous heart sounds. Some of the defects that accurate auscultation the nurse can detect are: (select all that apply).

- Atrial Septal Defect   

-Pericardial Rub

-Cardiac Tumor

-Mitral Regurgitation

-Aortic Stenosis

Answer 1

1)Atrial Sept Defect

An atrial septal defect (ASD) is a hole in the wall (septum) between the two upper chambers of your heart (atria). The condition is present at birth (congenital).

Small defects might be found by chance and never cause a problem. Some small atrial septal defects close during infancy or early childhood.

The hole increases the amount of blood that flows through the lungs. A large, long-standing atrial septal defect can damage your heart and lungs. Surgery or device closure might be necessary to repair atrial septal defects to prevent complications.Symptoms

Many babies born with atrial septal defects have no signs or symptoms. Signs or symptoms can begin in adulthood.

Atrial septal defect signs and symptoms can include:

Shortness of breath, especially when exercising

Fatigue

Swelling of legs, feet or abdomen

Heart palpitations or skipped beats

Stroke

Heart murmur, a whooshing sound that can be heard through a stethoscope

2) Pericardial Rub

The presence and documentation of a pericardial rub are of extreme importance since it is one of the four criteria to diagnose acute pericarditis. According to the 2015 European Society of Cardiology Guidelines for the diagnosis and management of pericardial diseases, acute pericarditis is diagnosable in the presence of two out of the four criteria: typical pericarditis chest pain, pericardial rub, diffuse ST-elevation or PR-depression on electrocardiogram and a new or worsening pericardial effusion.

Thus, detection of pericardial rub along with a new pericardial effusion, for example, meets the criteria and the patient should be treated as acute pericarditis. An untreated episode of acute pericarditis increases the risk of complications including recurrent, chronic and constrictive pericarditis.

A pericardial rub can also be indicative of left ventricular dilation after acute Q-wave anterior myocardial infarction since transmural infarct can irritate the pericardium (and cause pericarditis) and cause left ventricular failure.[8] The presence of pericardial rub after Q-wave anterior myocardial infarction might also carry a worse prognosis and indicate extensive ventricular damage after coronary angioplasty.[9]

Nursing, Allied Health, and Interprofessional Team Interventions

Because of available technologies, expertise in bedside examination has declined among medical professionals. For every patient who presents with chest pain suspicious for acute pericarditis, the nursing and medical team should attentively try to identify a pericardial rub over the left sternal border at different times, since the presence of the rub is variable during the day. Its detection modifies the patient's management since the presence of a pericardial rub is very specific for acute pericarditis.

3) Cardiac Tumor

Primary tumors of the heart are rare even in major cardiac surgery centers. Because of the low case numbers, there is an insufficient evidence base to determine the optimal treatment, particularly for malignant tumors.

Methods

The authors review the pertinent literature retrieved by a selective PubMed search on the terms “cardiac tumor,” “heart tumor,” “cardiac myxoma,” and “cardiac sarcoma.” They also present operative techniques and their own long-term results in 181 patients with cardiac tumors.

Results

Patients with cardiac tumors generally have nonspecific symptoms depending on the site of the tumor and the extent of infiltration into the neighboring tissue. The diagnosis is based on the clinical history, echocardiography (in most cases), and, sometimes, computerized tomography and magnetic resonance imaging. Autopsy studies reveal a 0.02% prevalence of cardiac tumors, of which 75% are benign and 25% malignant. Myxoma is the most common benign tumor (50–70%); angiosarcoma is the most common malignant one (30%), followed by rhabdomyosarcoma (20%). About 10% of all tumor patients develop cardiac metastases, but these are only rarely clinically manifest. From 1989 to 2012, 181 patients underwent surgery for cardiac tumors in the authors’ institution. The 5-year survival rates were 83% for benign tumors (139 patients), 30% for malignant tumors (26 patients), and 26% for cardiac metastases

4) Mitral Regurgitation

The left atrium tends to enlarge due to the extra blood volume leaking back from the ventricle. An enlarged atrium may develop a rapid and disorganized movement (atrial fibrillation), which reduces the heart’s ability to pump efficiently.

A fibrillating atrium quivers and doesn’t pump efficiently, which increases the risk for blood clots that may cause a stroke.

Another potential complication of mitral regurgitation is pulmonary hypertension.

Treatment for mild mitral regurgitation may include anticoagulation medication. However, surgery to repair or replace is often needed.

5)Aortic Stenosis

In addition to the symptoms of aortic stenosis, which may cause a patient to feel faint, weak, or lethargic, the wall of the left ventricle also may show muscular thickening because the ventricle must work harder to pump blood through the narrow valve opening into the aorta.

The thickened wall takes up more space inside the lower heart chamber that allows less room for an adequate amount of blood to be supplied to the body. This may lead to heart failure. Appropriate treatment can help reverse or slow down the progress of this disease

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