Pathophysiology Of ACS Essay

The accuracy of interqual criteria in determining the need for observation versus hospitalization in emergency department patients with chronic heart failure.

This study is relevant to the research question because they focused on testing n-terminal pro-b type natriuretic peptide and management of Heart Failure patients, however the patients were in a hospital in Canada. The study started with 534 patients from screening but 34 were excluded, and 17 patients did not participate after the first hospitalization, leaving 483 patients that were followed during the course of the study (Moe, Howlett, Januzzi, Zowall, 2007). The study used receiver-operating characteristic curve was used to analyze the data from the two groups (Moe, Howlett, Januzzi, Zowall, 2007). The tools used were clearly defined, reliable and valid. The researchers measured the proBNP level and physician initial diagnosis and then after they used the “logistic regression model” to predict whether knowledge of the proBNP levels aided in diagnosis and management of HF (Moe, Howlett, Januzzi, Zowall, 2007). The statistics used to analyze the date was relevant to the clinical research question. The study did not “perform age-stratified analysis” which may have an impact on the results, there was also a loss to follow up and the study was performed at multiple sites in Canada where as the patients for the clinical research question are located in Dallas service delivery area in United States of America (Moe, Howlett, Januzzi, Zowall, 2007). According to the researchers, the results of their study supported the “recently published HF consensus guidelines’” view that proBNP supports clinical diagnosis and cost effective care of patients (Moe, Howlett, Januzzi, Zowall, 2007). The implication of this study is that knowing the value of proBNP aids practitioners in the diagnosis and management of HF

Clearly differentiate the pathophysiology of angina and myocardial infarction, including signs and symptoms. (5 marks)

Heart failure (HF) is defined as a multifaceted clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. In HF, the heart may not provide tissues with adequate blood for metabolic needs, and cardiac-related elevation of pulmonary or systemic venous pressures may result in organ congestion1. In the United States, HF is increasing in incidence with about 5.1 million people suffering from HF and half of people who develop HF die within 5years 2. Over 75% of existing and new cases occurred in individuals over 65 years of age, < 1% in individuals below 60 years, nearly 10% in those over 80 years of age. HF costs the

The pathophysiology of ACS includes the stable plaque forms get converted into unstable plaque forms.2 These unstable plaque forms have numerous thin fibrous cap cells, inflammatory cells, activated macrophages, and smooth muscle cells. Sympathetic activity increases myocardial contractility, pulse rate, blood pressure, and coronary blood flow which leads to plaque rupture or fissure. As the artery ruptures, it causes thrombus formation and ischemia in this particular artery. Depending on the condition, different thrombi could form. The unstable angina forms a small thrombus formation, NSTEMI forms a partial thrombus formation, and STEMI forms a complete and persistent thrombus. The risk factors involved in ACS are age, physical inactivity, and history of hypertension, diabetes, or angina. The signs of acute coronary syndromes are an acute heart failure, tachycardia, bradycardia, or heart blockage, and the symptoms of ACS consist of chest pain, pain in the extremities, nausea, shortness of breath, heavy

A further multivariate regression analysis revealed that the lowest tertile of serum P1NP concentration (≤29.3µg/L) was found to be significantly associated with nursing home residence (P-value 0.034) after adjustment for age, gender and presence of hypertension; and also to be inversely associated with ALP (P-value 0.000), OC (P-value 0.000) and β-CTX (P-value 0.001) after adjustment for age, gender, ALP, OC, and β-CTX.

I tried to understand why PMG asking now about Hospital NPI number for BCBS? anyway I did some research and I see that BCBS reject the claims for:

Research by the American Heart Association (2014) states that heart failure effects an estimated 5.1 million Americans and it is predicted to increase 25% by 2030. Heart failure is a pathophysiological condition that indicates the heart is unable to promote enough cardiac output causing insufficient blood supply to the body. Pharmacological treatment for cardiac failure is dependent upon the ability to decrease rate of blood flow and blood pressure. Survival after heart failure diagnosis has improved with medication but the death rate remains high with over half of the people diagnosed with heart failure will die within 5 years. (Go et al., 2014)

According to the American Heart Association, congestive heart failure physicians use a physical examine and other tests to diagnose heart failure ("Common Tests," 2017). The National Heart, Lung and Blood Institute state the a chest x-ray, laboratory blood test called a BNP, and an echocardiogram are used to test to help determine if a person has congestive heart failure ("How is heart ," 2015). Heart failure affects all ages with the greatest

Heart failure diagnoses are carried out by a specialized medical practitioner. It comprises of holistic patient health review such as patient medical history, patients symptoms, lungs con-gestion assessment, carrying out physical activity under observation, assessing for fluid re-tention (edema) and also assessing risk factors such as Coronary artery diseases, high blood pressure, Diabetes. According to tansy (2010 1399), heart failure can be diagnosed using different test methods such as Blood tests. This helps to check for any possible diseases in the thyroid, kidney or liver that can cause heart problems (NT-proBNP). N--terminal pro-B-type natriuretic peptide is a chemical checked in the blood. When the heart is under stress BNP is secreted

With new research emerging, new tests and measures are being discovered to provide potential additions to improve the diagnostic and treatment process. One of these is the B-type natriuretic peptide (BNP). According to Porapakkham, Porapakkham, Zimmet, &, Billah, B., & Krum (2010), BNP is a neurohormone primarily released from the heart’s ventricles in response to the stretch that is received when the heart is filling. The greater the stretch received by the heart, more of the neurohormone is released into the bloodstream. This has been seen as an invaluable and also a minimally invasive indicator of volume status and a measurable value of the heart’s ability as a pump. My question arose from the curiosity of whether using BNP as a guide in treatment of heart failure patients will provide better clinical and subjective outcomes not just for the patients but also for treating practitioners. The following is the summary and synthesis of the articles, Meta-analysis and practice guideline that pertains to the PICO question

Hyperkalaemia and hypokalaemia can be a critical effect on the heart, thus, measurement of serum electrolytes is also crucial for Mr. Peters (Brown & Edwards 2015). Lipid profiled also needs to be conducted for HDL and LDL, and BGL and HbA1c may be carried out, since Mr. Peter has DM (Berman, Kozier & Erb 2015). The elevated serum lipid level indicates the high risk of development of further CVS dysfunction, which may be an important resource for patient education on diet and lifestyle (Berman, Kozier & Erb 2015). A brain natriuretic peptide (BNP) test is important as the serum level of BNP has a significant relevance in NSTEMI (Mahmoud et al.

As blood pressure rises and “the blood moves with enough force, [it] increases the chances of tearing that plaque loose” and rupturing it (Sapolsky, 2004, p. 45). When a rupture occurs, the material that has become loose, a blood clot known as a thrombus, can pose as much more of a threat to a person’s life than the initial build up of plaque. If the thrombus blocks a coronary vessel then the heart muscle is unable to receive blood that is full of needed oxygen and other essential nutrients, this is known as cardiac ischemia (Steffen, Lecture 11). Ischemia can cause angina and discomfort. Another possible result of a blocked coronary artery is a heart attack, which can lead to death, and if a blood vessel in the brain is clogged then a stoke will occur.

There is a lack of consensus about the domains that should be assessed and what assessment tools should be used [145]. The existing measurement tools may not cover all of the domains that are impacted by and relevant to the LBP condition. In this way, the patients may overestimate or underestimate their health status, which may affect the treatment decision. Furthermore, there is no single comprehensive measure to assess patients’ health outcomes. To comprehensively assess patients, multiple questionnaires are needed, and this consumes time for both patients and clinicians and introduces extra challenges, such as lack of coordinated efforts to collect and standardize the PRO instruments and analyse their results [33].

Patient population was divided into two groups that included NT-pro-BNP level of more than 525 pg/mL (Group1) and NT-pro-BNP less than or equal to 525 pg/mL (Group2). These cutoff points were decided based on the NT-pro-BNP median. Descriptive statistics for the continuous variables were reported as mean ± standard deviation while categorical variables were summarized as frequencies and percentages. Chi square test was used to measure the association of the primary and secondary outcomes with NT-Pro-BNP. The level of statistical significance was set at a p < 0.05. All the statistical analysis on the data was done using SAS software package version 9.4 (SAS Institute Inc., NC, USA).