Hypertrophic cardiomyopathy (HCM), a common congenital heart disease, is the leading cause of sudden cardiac death in adolescents, young adults, and athletes. Older adults with HCM are less likely to experience sudden cardiac death, but their quality of life can be impaired. This article discusses diagnostic criteria, treatments, and nursing interventions, including patient teaching, for adults with HCM.
A 47-year-old man comes to your ED with complaints of chest pain that radiates to his neck, nausea, shortness of breath (SOB), and weakness on one side of his body. The triage nurse notes that he's diaphoretic, pale, and appears apprehensive. His heart rate is 116 and his BP is 188/104. The patient states that the chest pain occurred suddenly without any precipitating factors. A 12-lead ECG reveals sinus tachycardia. This patient may be experiencing acute aortic syndrome-a term that encompasses aortic dissection, penetrating atherosclerotic ulcer, intramural hematoma, aortic aneurysmal leakage, and ruptured abdominal aortic aneurysm. Can you recognize this life-threatening emergency?
How does it happen?To understand how an aortic dissection occurs, let's fi rst look at the anatomy of the aorta. The aorta is the largest artery in the body, composed of three layers: inner, middle, and outer. The inner layer-the tunica intima-is a thin, delicate layer in which blood fl ows through. The middle layer-the tunica media-gives the aorta its strength and elasticity. When this middle layer weakens, the outer layer-the tunica adventitia-swells and forms an aneurysm (see Picturing a dissecting aneurysm).The pulsing pressure of arterial blood fl owing through the aorta continues to weaken the vessel walls, and the aneurysm continues to enlarge further than its normal 2 to 5 cm (0.8 to 2 in) diameter. If the extension continues, the weakened inner layer may tear. This tear will allow the blood to fl ow freely between the arterial walls, causing a separation or dissection.
Who's at risk?There are several risk factors for aortic dissection. The majority (over 70%) of patients who experience an aortic dissection have a history of hypertension. The increase pulse pressure of continuous hypertension damages the muscle layers of the aorta, leaving it vulnerable to dissection.Other risk factors include: • gender-aortic dissection is three times more common in men than women • race-Black patients are at increased risk • age-roughly 75% of aortic dissections occur in people between the ages of 40 and 70, but risk peaks in the 60s and 70s • genetic connective tissue disorders-Marfan syndrome, Ehlers-Danlos syndrome, and Turner syndrome • genetic cardiac anomalies-coarctation of the aorta (a narrowing in the descending aorta) or bicuspid aortic valve (causes blood to regurgitate and increases aortic dilation) • blunt trauma-a blow to the aorta can cause a tear and subsequent acute dissection; the patient's chest hitting the steering wheel during a motor vehicle accident is the most common trauma cause
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