Treatments for Heart Murmur
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Palpitations:
Treatment
(In a Page: Signs and Symptoms)
-
Attention to airway, breathing, and circulation
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Treat the underlying cause
-
Discontinue offending drugs
-
Anxiolytics may be needed for significant anxiety
-
Administer adenosine, amiodarone and/or other antiarrhythmics, β-blockers, diltiazem, digoxin as indicated for rate control, suppression, or cardioversion
-
Electrophysiologic intervention (radiofrequency ablation of re-entrant pathway) may be necessary for symptomatic patients
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Murmurs - Diastolic:
Treatment
(In a Page: Signs and Symptoms)
-
Attention to hemodynamic status
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Treat the underlying cause (e.g., anemia, infection, hyperthyroidism, MI)
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Serial examinations to track progression of underlying cause
-
Valve repair or replacement may be indicated for severe valvular disease
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Murmurs - Systolic:
Treatment
(In a Page: Signs and Symptoms)
-
Attention to hemodynamic status
-
Treat the underlying cause (e.g., anemia, infection, hyperthyroidism, MI)
-
Serial examinations to track progression of underlying cause
-
Valve repair/replacement may be indicated for severe valvular disease
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Abdominal Bruit:
Treatment
(In a Page: Signs and Symptoms)
-
Initial treatment is to stabilize and resuscitate the patient as needed
–Attention to airway, breathing, and circulation
–Immediate repair of ruptured abdominal aneurysm
Treat the underlying etiology
Vascular surgical consultation may be necessary for severely stenotic and/or symptomatic vessels
Nephrology consult may be needed for renal insufficiency or to help with appropriate medication choices
Treat hypertension if present
–Always avoid ACE inhibitors in patients with bilateral renal artery stenosis
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Carotid Bruits:
Treatment
(In a Page: Signs and Symptoms)
-
Patients with symptomatic stenosis (i.e., presence of TIA symptoms in the appropriate distribution) and >70% carotid stenosis confirmed on duplex ultrasound should strongly consider carotid endarterectomy
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Symptomatic patients with 50–69% stenosis have greater benefit from surgery than from medical approach
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Asymptomatic patients and those that cannot tolerate surgery should begin aspirin (60–325 mg/day) and/or antiplatelet therapy (e.g., ticlopidine, clopidogrel)
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Smoking and alcohol cessation
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Treat hypertension, diabetes, and hyperlipidemia
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Carotid angioplasty is currently under study
-
Patients with underlying disease processes require appropriate treatment
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Breath Sounds (Decreased):
Treatment
(In a Page: Signs and Symptoms)
-
Closely monitor airway, breathing, and circulation
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Administer supplemental O2 as needed
-
Treat underlying etiology (e.g., removal of foreign body, bronchodilators, steroids)
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Emergent interventions may be necessary (e.g., chest tube insertion)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Abnormal Heart Sounds:
Treatment
(In A Page: Pediatric Signs and Symptoms)
- Innocent murmurs
–Parental reassurance that this is a normal, common finding in children representing normal blood flowing through a normal heart, usually disappearing with age (as the patient grows, the stethoscope is farther from the heart, so the sound isn’t heard)
–The murmur may get louder during times of increased cardiac output (i.e., illness, fever, dehydration, activity, or other stress)
–No bacterial endocarditis prophylaxis required
-
Abnormal findings requiring referral
–Abnormal S2 (single or widely split)
–Holosystolic/regurgitant murmur
–Any diastolic sounds
–Systolic ejection clicks: “Harsh” murmurs
–Any murmur with cardiac symptoms
-
Further treatment is dependent on underlying anatomy and physiology
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Tachycardia/Palpitations:
Treatment
(In A Page: Pediatric Signs and Symptoms)
Sinus tachycardia: Treat underlying cause
- Acute therapy for SVT
–Vagal maneuvers increase vagal tone at AV node, lengthening the refractory period and breaking re-entry SVT: Ice to face (<1 year old), blowing hard on thumb (toddler/child), carotid massage (teenager)
–Adenosine: Increases refractory period of AV node better than vagal maneuvers by causing temporary AV block that breaks re-entry SVT; short (10 sec) half-life, so must give fast via IV push; side effects include hypotension (transient), chest tightness/pain, sense of “impending doom”
–Synchronized cardioversion all unstable tachycardias (especially V-fib and pulseless V-tach)
- Chronic therapy for re-entry SVT
–β
-blockers, digoxin (not in WPW), calcium channel blockers (not if <1 year old), other antiarrhythmics
–Ablation of bypass tract via cardiac catheterization
>>>>>> >>
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Palpitations:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
If the patient complains of palpitations, ask him about dizziness and shortness of breath. Then inspect for pale, cool, clammy skin. Take the patient’s vital signs, noting hypotension and an irregular or abnormal pulse. If these signs are present, suspect cardiac arrhythmia. Prepare to begin cardiac monitoring and, if necessary, to deliver electroshock therapy. Start an I.V. line to administer an antiarrhythmic, if needed.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Bruits:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Instruct the patient to inform the physician if he develops dizziness, pain, or any symptom that suggests a stroke because this may indicate a worsening of his condition.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Murmurs:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Instruct the patient to contact his physician before undergoing invasive procedures or dental work because prophylactic antibiotics may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Palpitations:
Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient complains of palpitations, ask him about dizziness and shortness of breath. Inspect for pale, cool, clammy skin. Take the patient’s vital signs, noting hypotension and irregular or abnormal pulse. If these signs are present, suspect cardiac arrhythmia. Prepare to begin cardiac monitoring and, if necessary, to deliver electroshock therapy. Start an I.V. line to administer an antiarrhythmic, if needed.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Murmurs:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Prepare the patient for diagnostic tests, such as electrocardiography, echocardiography, and angiography. Administer an antibiotic and an anticoagulant as appropriate. Because any cardiac abnormality is frightening to the patient, provide emotional support.
Patient teaching
Instruct the patient to contact his physician before undergoing invasive procedures or dental work because prophylactic antibiotics may be necessary. Explain the signs and symptoms the patient should report.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Palpitations:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Prepare the patient for diagnostic tests, such as an electrocardiogram and Holter monitoring. Provide supplemental oxygen, as indicated. Assess the patient for electrolyte imbalances as a potential cause for the condition. To alleviate the anxiety that may arise with palpitations, provide a quiet, comfortable environment.
Patient teaching
If the patient’s palpitations are related to anxiety, provide information about anxiety and stress management. Refer him to community support services for stress management and therapy. Reinforce the need to avoid caffeine and provide information on alcohol and smoking cessation programs, as appropriate.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Bruits:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Instruct the patient to inform the physician if he develops dizziness, pain, or any symptom that suggests a stroke because this may indicate a worsening of his condition. For the patient with atherosclerosis or peripheral vascular disease, discuss lifestyle modifications, such as stopping smoking, exercising regularly (after consulting with the physician), and eating a healthy diet.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Murmurs:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Although not usually a sign of an emergency, murmurs — especially newly developed ones — may signal a serious complication in patients with bacterial endocarditis or a recent acute MI. When caring for a patient with known or suspected bacterial endocarditis, carefully auscultate for any new murmurs. Their development along with crackles, distended jugular veins, orthopnea, and dyspnea may signal heart failure.
Regular auscultation is also important in a patient who has experienced an acute MI. A loud decrescendo holosystolic murmur at the apex that radiates to the axilla and left sternal border or throughout the chest is significant, particularly in association with a widely split S2 and an atrial gallop (S4). This murmur, when accompanied by signs of acute pulmonary edema, usually indicates the development of acute mitral insufficiency due to rupture of the chordae tendineae — a medical emergency.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Palpitations:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient complains of palpitations, ask him about dizziness and shortness of breath. Then inspect for pale, cool, clammy skin. Take the patient’s vital signs, noting hypotension and irregular or abnormal pulse. If these signs are present, suspect cardiac arrhythmia. Prepare to begin cardiac monitoring and, if necessary, to deliver electroshock therapy. Start an I.V. line to administer an antiarrhythmic, if needed.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Bruits:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Frequently check the patient's vital signs, auscultate over the affected arteries, and monitor peripheral pulses.
▪ Check for bruits that become louder or develop a diastolic component.
▪ Administer prescribed drugs, such as a vasodilator, an anticoagulant, an antiplatelet drug, or an antihypertensive, as needed.
▪ Prepare the patient for diagnostic tests, such as blood studies, X-rays, an electrocardiogram, cardiac catheterization, and ultrasonography.
Patient teaching
▪ Teach the patient signs and symptoms of a stroke and to seek immediate medical attention if they occur.
▪ Discuss lifestyle changes, such as smoking cessation, exercising regularly, and eating a balanced diet.
▪ Teach the patient about the cause of the specific bruit and the treatment plan after a diagnosis is established.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Murmurs:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for diagnostic tests, such as electrocardiography, echocardiography, and angiography.
▪ Administer an antibiotic and an anticoagulant as appropriate.
▪ Because a cardiac abnormality is frightening to the patient, provide emotional support.
▪ Monitor the patient's heart rhythm and vital signs.
Patient teaching
▪ Explain the use of prophylactic antibiotics.
▪ Explain signs and symptoms that require prompt medical attention.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Palpitations:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for diagnostic tests, such as an electrocardiogram and Holter monitoring.
▪ Maintain a quiet, comfortable environment to minimize anxiety and perhaps decrease palpitations.
▪ Monitor for signs of reduced cardiac output and cardiac arrhythmias.
▪ Prepare the patient for cardioversion, if indicated.
▪ Provide supplemental oxygen.
Patient teaching
▪ Explain all diagnostic tests and procedures.
▪ Teach the patient how to reduce anxiety.
▪ Explain the disorder and treatment plan.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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