Medical-surgical Nursing Demystified

CHAPTER 1 Cardiovascular System^27

HALLMARK SIGNS AND SYMPTOMS

• Asymptomatic—Many clients with hypertrophic cardiomyopathy (HCM)
  are asymptomatic. Those with signs do not present until their mid-twenties.


• Dyspnea—The most frequent symptom is shortness of breath due to increase
  pressure in the lungs. The heart may not sufficiently relax resulting in higher
  pressure and a backup of blood into the lungs.


• Angina—Clients experience chest pain related to increase oxygen demand
  of the extra heart muscle and due to thick, narrowing coronary blood vessels
  within the heart’s wall


• Syncope—Fainting is caused by heart arrhythmias related to the inability of
  the cardiac muscle to conduct electrical impulses.


• Sudden death—Young adults are at risk of sudden death during physical
  exercise resulting from ventricular fibrillation, which is a cardiac arrhythmia.


• Abnormal heart sounds
  
  
  • Murmur, which is the sound of turbulence results from abnormal blood flow
  
  
  • S3, which is a third heart sound commonly heard in heart failure. S3 is a
    soft sound made by the vibration of the ventricular wall when the ventri-
    cle fills too rapidly. S3 is heard after the S2 heart sound and is best found
    over the apex of the left ventricle, which is the fourth intercostal space
    along the mid-clavicular line
  
  
  • S4, which is the heart sound heard before the S1 heart sound is the result
    of the heart being too stiff. This is vibration of the valves and the ven-
    tricular walls when the atria contracts and the ventricles fill.
  
  
  
  

INTERPRETING TEST RESULTS

• Chest x-ray (CXR) shows enlarged heart, pulmonary congestion.


• Echocardiography shows left ventricular hypertrophy (LVH) and dysfunc-
  tion in dilated and hypertrophic cardiomyopathy; small ventricular size and
  function in restrictive cardiomyopathy.


• Electrocardiogram: ST changes, conduction abnormalities, LVH.
  
  
  • Left ventricular hypertrophy shows as a broad QRS wave, usually in leads
    4, 5, and 6 because of high voltage.
  
  
  
  


• Cardiac catheterization—to measure chamber pressures, cardiac output, ven-
  tricular function, but is often unable to add to information that has already
  been received from echocardiogram.