At least once a year, the media report on a seemingly healthy teenage athlete collapsing during a sports game and dying of heart complications. These incidents continue to outline the importance of physical exams and health screenings for teenagers, especially those who play sports. During these health screenings, examiners check for cardiovascular alterations such as heart murmurs because they can be a sign of an underlying heart disorder. Since many heart alterations rarely have symptoms, they are easy to miss if health professionals are not specifically looking for them. Once cardiovascular alterations are identified in patients, it is important to refer them to specialists who can further investigate the cause.

Consider the following scenario:

A 16-year-old male presents for a sports participation examination. He has no significant medical history and no family history suggestive of risk for premature cardiac death. The patient is examined while sitting slightly recumbent on the exam table and the advanced practice nurse appreciates a grade II/VI systolic murmur heard loudest at the apex of the heart. Other physical findings are within normal limits, the patient denies any cardiovascular symptoms, and a neuromuscular examination is within normal limits. He is cleared with no activity restriction. Later in the season he collapses on the field and dies.

To Prepare

Review the scenario provided, as well as Chapter 25 in the Huether and McCance text. Consider how you would diagnose and prescribe treatment for the patient.

Select one of the following patient factors: genetics, ethnicity, or behavior. Reflect on how the factor you selected might impact diagnosis and prescription of treatment for the patient in the scenario.

Post a description of how you would diagnose and prescribe treatment for the patient in the scenario. Then explain how the factor you selected might impact the diagnosis and prescription of treatment for that patient. Assignment Cardiovascular Alterations

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Cardiovascular Alterations

Introduction

The Cardiovascular Alterations (CA) examination is a vital part of any cardiology evaluation. This examination includes measuring the size and function of the heart, lungs, and blood vessels. The CA exam may also include imaging studies such as cardiac ultrasound or echocardiography if indicated by findings on physical exam or ECG findings.

Cardio-Thoracic Ratio (CTR)

The Cardio-Thoracic Ratio (CTR) is a ratio of the heart’s size to the chest cavity. It can be measured on portable CXRs, which are similar to ultrasound machines but do not require an external probe. Measurement of CTR can help determine if a patient needs additional imaging (a CXR or an ultrasound).

The normal range for this measurement is 0.50 – 0.55 in adults with no history of cardiovascular disease or chest pain; however, some studies have shown that this ratio may be higher in patients who have been treated with beta-blockers or ACE inhibitors for hypertension

Measurement of the ratio of the heart’s size in the anterior-posterior diameter to the chest cavity in which it resides

Measurement of the ratio of the heart’s size in the anterior-posterior diameter to the chest cavity in which it resides

The normal range is 0.5-0.55, however any value outside this range can be indicative of cardiomegaly or dilated cardiomyopathy. The critical tool used in determining if a patient has cardiomegaly is called CTR (chest wall thickness) and is measured on portable CXRs using a caliper or calipers (see picture below).

Normal values are 0.50 – 0.55 and this is a critical tool used in determining if a patient has cardiomegaly

• Normal values are 0.50 – 0.55 and this is a critical tool used in determining if a patient has cardiomegaly.

• It can be a useful way to determine if additional imaging is needed, or if the findings on cardiac catheterization should prompt further evaluation for heart failure or other conditions with similar symptoms (e.g., hypertrophic cardiomyopathy).

The CTR is measured on portable CXRs and may help determine if a pt requires additional imaging (a CXR or an ultrasound)

The CTR is a ratio of the heart size to the chest size. A normal CTR is 0.50 – 0.55, while an abnormal CPR >0.55 suggests cardiomegaly and an abnormal CPR <0.50 suggests cardiomegaly

A widened CTR (>0.55) is not diagnostic for cardiomegaly, but does suggest it as an abnormality that needs further investigation

• CTR is not diagnostic for cardiomegaly.

• CT pulmonary angiography (CTPA) is an important tool to help determine if a patient needs additional imaging, such as CXR or ultrasound.

The CTR is an important tool for determining cardiomegaly and should always be included in reports when assessing portables.

The CTR is an important tool for determining cardiomegaly and should always be included in reports when assessing portables. It is a measurement of the heart’s size in the anterior-posterior diameter to the chest cavity in which it resides. Normal values are 0.50 – 0.55, with greater than 0.60 being considered cardiomegaly (1). A CT scan can easily detect this alteration in patients’ hearts, allowing for accurate diagnosis and treatment planning for these patients who may be experiencing development or progression of their condition (2).

Conclusion

The CTR provides a reliable tool in assessing the size of the heart and helps determine if there is any requirement for additional imaging. Importantly, it does not provide a diagnosis of cardiomegaly, but simply allows us to rule out conditions that may mimic this particular abnormality on standard CXRs.