Running head: VENTRICULAR HYPERTROPHY

Ventricular Hypertrophy:
A Working Case Scenario of Potential
Risk and Detection

Cool Hand Luke

Middle Tennessee State University
Pathophysiology - NURS-3010-D01
March 5th, 2011

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Abstract
Ventricular hypertrophy or, specifically in this case scenario, left ventricular hypertrophy (LVH)
is a frequent and well known consequence of chronic elevated blood pressure. LVH actually
develops as a result of numerous forms of cardiac stress including but not limited to
pressure/volume overload and contractility loss. Contributing factors such as age, obesity,
alcohol consumption, catecholamines, aldosterone production and even genetic factors are
widely considered significant risk factors for this cardiac disorder. To this end. LVH is
associated with increased incidences of congestive heart failure, ventricular arrhythmias,
myocardial infarction, carotid arthrosclerosis, and sudden cardiac death, which is why a properly
planned and significantly thorough nursing assessment conducted upon any patient complaining
of chest pain is critical. The scenario in this paper endeavors to present such a case, and walk the
reader through what should be done. In addition, a selected article review of LVH is also
discussed.

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Ventricular Hypertrophy:
A Working Case Scenario of Potential Risk and Detection

Introduction
As briefly stated in the abstract, this paper explores a scenario whereby a patient, after
examination, is determined to possess the potential for left ventricular hypertrophy (LVH). LVH
usually develops as a result of long term elevated blood pressure (Bauml and Underwood,
2010). There is a wide range of contributing factors which precipitate this cardiac disorder,
however in this particular scenario the factors of age, obesity and alcohol consumption will be
the ones of focus (Gardin et al, 1997).
Approaching strictly from an organizational standpoint, this paper will summit the scenario
in the form of a nursing assessment. The segments of this nursing assessment includes: (1) A
Case Synopsis, (2) A Health History, (3) Biographical Data, (4) Past Health History, (5) Family
History, (6) Physical Assessment, (7) A Focused Physical Assessment and (8) Finding. After the
findings, a brief review of an article addressing this condition will be presented.
As stated earlier, undetected and thusly untreated LVH most often leads to a host of lifethreatening conditions including, but not limited to, congestive heart failure, ventricular
arrhythmias, myocardial infarction, carotid arthrosclerosis, and, ultimately, cardiac death. A
thorough nursing assessment is a crucial first step in heading off these potential problems and,
hopefully, granting the patient the opportunity to live a longer and healthier life (Okin et al.,
2002).

I.

A Case Synopsis

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Mr. Raymond Givens, an 82 year old white male, arrives in the emergency room of Baptist
Hospital complaining specifically of chest discomfort. He states that it started 2 hours ago
after he finished his dinner. The discomfort was significant enough to awaken him from his
nap. Mr. Givens is known to some of the staff of the hospital. He has been treated for
hypertension for the past 4 years at this facility. Based upon his history of hypertension and
this most recent incident of chest discomfort, Mr. Givens is given aspirin and started on a
nitroglycerin drip. The aspirin is administered in an effort to thin the viscosity of his blood,
while the nitroglycerin drip is given to quickly dilate the diameter of his blood vessels. All of
this, of course, aids with increase of blood circulation to the heart or any other place which
may be experiencing ischemia.

Subsequently, through a physician's order, an

electrocardiogram and serum cardiac enzyme test are obtained. As a result, Mr. Givens is
admitted to the cardiac care unit with an initial diagnosis of an anterior wall myocardial
infarction. Mr. Given's condition, at this point, is critical.

II.

A Health History
The Chief Complaint: I have terrible chest pain. The patient states that discomfort started
after eating dinner; the intensity of the pain woke him up from a nap. Patient is a smoker; he
states smoking approximately a pack of cigarettes a day. His recent meal was fairly large.
Patient states that he initially thought that the pain was due to indigestion, so as a result he
consumed some over-the-counter antacid, but no relief from the pain came. When the
patients condition stabilizes, a complete health history is conducted.

III.

Biographical Data

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Here presented is an 82 year old white male, married, father of seven grown children. He is a
self employed entrepreneur; he obtained a bachelors degree in engineering. Patient was born
and raised in the United States and is of Italian descent. His religious preference is
Catholicism.

Patient has Blue Cross/Blue Shield medical health insurance. Source of

information is himself, deemed reliable.

IV.

Past Health History

Patient's previous electrocardiogram revealed left ventricular hypertrophy; he has been
hospitalized for hypertension. He has no known food, drug or environmental allergies; he
has no other previous medical problems.
problems with overweight issues.

Patient receives little exercise and has had

He possesses no other prescribed medication except

Enalapril (Vasotec) 5 mg twice a day for which he has already taken two doses. In addition,
he has consumed an antacid for- what he believed to be-indigestion.

V.

Family Health History

Patient states that his family has a history of hypertension, myocardial infarction, and stroke.
His father suffered from a stroke and his two uncles experienced hypertension and a
myocardial infarction respectively.

VI.

Physical Assessment
Patient's general appearance is well-developed, well-groomed but in obvious discomfort. He
sits upright clutching his chest. He is alert and responsive and oriented to person, place time
and reason for visit. Patient's vital signs are: temperature 100 degrees, pulse rate 115 beats
per minute with a strong rhythm that occasionally affords an extra beat; respiration rate at 28

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breaths per minute, however shallow in nature. Patient's blood pressure is 170/106 and his
height is 6 feet 1 inch tall, weighing 275 pounds. Integumentarily, patient's skin is intact,
pale/ashen, diaphoretic, but good has skin turgor. Mucous membranes are pale gray and
moist; he has poor capillary refill and negative clubbing. His skin is cool, pale, shiny, and
hairless on his lower extremities.

In evaluating his head, eyes, ears, nose, and throat

(HEENT), his eyes exhibited negative periorbital edema, positive arcus senilis, funduscopic.
He exhibited negative signs of papilledema and/or hemorrhaging. Patient's thyroid was not
palpable. Evaluating respiratory systems, his lungs revealed bibasilar crackles and he has
decreased breath sounds at the bases because of his guarded respirations. He has a plus 1
peripheral pulses. Gastointestinally, his abdomen appears large, round, soft, and non-tender;
he shows positive pulsation in epigastria region but is negative for bruits or thrills.
Evaluating the musculoskeletal / neurologic systems, his sensory appears intact. He has a
plus 2 deep tendon reflexes with muscle strength bilaterally equal.

Patient possesses

bilateral hand grip, with lower extremities displaying an approximate plus 4 out of 5 muscle
strength.

VII.

Focused Physical Assessment

Patient's has positive carotid pulsation exhibiting plus 2 symmetrical with a smooth, sharp
upstroke and rapid descent. His artery is sniff, negative for thrills and bruits. Patient's neck
vein is distended, with jugular venous pressure at 30 degrees > 3cm, possessing abdominal
jugular reflux. Patient positive sustained pulsations displaced lateral to apex, the point of
maximum impulse is 3cm (amplitude). He has slight pulse action appreciated at LLsb and
base, but not quite as pronounced. Patient possesses negative thrill, patient's cardiac border

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percussed within the third, fourth, and fifth intercostals space to the left of the mid-clavicle
line. Heart sound appreciated with tachycardia and irregular rhythm at apex S 1 < S2 negative
split at base, right S1 < S2 with a decently accentuated S2, patient negative for murmurs and
pericardial rubs.
VIII.

Findings
The question here is, based on the assessment, what are the areas of most concern? The areas
of most concern are the patient's cardiovascular and respiratory systems. According to the
assessment the PMI is enlarged; this is due to signs of hypertension and left ventricular
hypertrophy. Mr. Given's physical findings also revealed neck vein distension and an
elevated jugular venous pressure. These findings reveal signs of right-sided heart failure.
The patient suffers from a decreased cardiac output and ineffective tissue perfusion,
improving the condition of these problems is essential to his health and future wellbeing.
This can be accomplished through medication and lifestyle changes which include weight
management, diet and ceasing smoking habits.

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The selected article for this paper:
Bauml, Michael A & Underwood, Donald A. Left ventricular hypertrophy: An overlooked
cardiovascular risk factor. Cleveland Clinic Journal of Medicine, 77, (6), June 2010

Overview
The authors believe that LVH recent evidence indicates that this disorder is a modifiable risk
factor that may not necessarily be entirely dependent on blood pressure control; in this much,
they review its pathogenesis, diagnosis, and treatment in coming to their conclusion. They
acknowledge that LVH is caused by a chronically increased cardiac workload whereby the
consensus in the medical community is that it is most commonly caused from hypertension.
They argue that patients who have this disorder should undergo echocardiography to screen for
LVH, using specifically the calculated left ventricular mass index. The equally argue that
electrocardiography is too insensitive to be used alone to screen for LVH. The chief argument
for hypertensive patients is that they should undergo therapy consisting of an angiotensin II
receptor blocker or an angiotensin-converting enzyme inhibitor. They contend that treatment
induced regression of LVH improves cardiovascular outcomes independent of blood pressure.
Overall it is a very informative article to read about the subject.

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References
Bauml, M. A. & Underwood, D. A. (2010). Left ventricular hypertrophy: An overlooked
cardiovascular risk factor. Cleveland Clinic Journal of Medicine, 77(6), 381-387.
Gardin, J. M., et al. (1997). Left ventricular mass in the elderly. The cardiovascular health study.
Hypertension, 29, 10951103.
Okin, P.M., Wright J.T., Nieminen, M.S., et al. (2002). Ethnic differences in
electrocardiographic criteria for left ventricular hypertrophy: the LIFE study. Losartan
intervention for endpoint. Am J Hypertens, 15(8), 663671.