The appreciation of a grade II/VI systolic murmur warrants further examinations to come up with a definitive diagnosis. Heart murmurs are caused by the turbulent flow of blood near the heart or through heart valves (Huether & McCance, 2017). It is thus, indicative of a structural defect, which can best be determined by echocardiography (Begic et al., 2016). An electrocardiogram or chest x-ray may be used to reveal salient structural changes, after which an echocardiography may be done to confirm the diagnosis. Cardiac MRI, stress testing, and cardiac catheterization could also be used to assess the severity of the condition to inform medical decision on the choice of the patient’s treatment plan (Begic et al., 2016).
Treatment options would include exercise restriction and other heart-healthy lifestyle changes (NHLBI, 2019). However, activity restriction should be determined based on the patient’s functional capacity. Medicines may be prescribed to correct underlying conditions (NHLBI, 2019). Depending on the severity of the patient’s condition, surgical procedures like heart valve surgery could be recommended to correct any identified defects (NHLBI, 2019). Indication for surgery should be individualized. The surgery risk should be considered and the decision to operate should be made after an informed consent has been received. More importantly, the possibility for regular follow-up should be considered.
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An important patient factor, in this case, is behavior; regular engagement in physical activity. Exercise stress testing would be critical to the patient’s diagnosis. Additionally, since the patient is asymptomatic, it would be important to conduct an exercise stress test tailored to the intensity of physical activity before deciding to limit the patient’s participation in sports (Gati, Malhotra & Sharma, 2018). Surgery would preclude the patient’s participation in sports as some time would be required for the restoration of function and exercise capacity. Moreover, it is vital to note that if the patient's sport involves collision or contact, anticoagulant therapy would increase his risk of bleeding.
References
Begic, Z., Pesto, S., Dinarevic, S., Begic, E., Dobraca, A., & Masic, I. (2016). Evaluation of Diagnostic Methods in the Differentiation of Heart Murmurs in Children. Acta Informatica Medica , 24 (2), 94-98. doi: 10.5455/aim.2016.24.94-98
Gati, S., Malhotra, A., & Sharma, S. (2018). Exercise recommendations in patients with valvular heart disease. Heart , 105 (2), 106-110. doi: 10.1136/heartjnl-2018-313372
Huether, S., & McCance, K. (2017). Understanding pathophysiology (6th ed.). Saint Louis, Missouri: Elsevier Mosby.
NHLBI. (2019). Heart Valve Disease. Retrieved 26 September 2019, from https://www.nhlbi.nih.gov/health-topics/heart-valve-disease
