Patient Vasospasm Case Study

To determine if the patient’s chest pain is related to cardiac ischemia, you would look for ST-segment depression and/or T wave inversion. If the ST-segment depression is at least 1mm (one small box) below the isoelectric line, it is significant and occurs in response to inadequate supply of blood and oxygen, which leads to an electrical disturbance. Once this is treated, adequate blood flow is restored, the ECG changes will resolve, and the ECG will return back to patient’s baseline.

This ECG will be systematically interpreted using the mnemonic A RARE PQRST. By utilising this mnemonic, it is easy to determine that the patient is experiencing an anterior STEMI, which results from an occlusion of the left anterior descending artery.

More blood, causing a high force within the Left Ventricle and left atrium. This weight backs up

If the perkinje fibers or the AV node becomes irritated, they can begin contraction of the ventricles at speeds well above normal. Other causes of ventricular tachycardia include heart disease and medications.

I. Description: Congestive Heart Failure is more of a syndrome than a disease. Heart failure may be classified according to the side of the heart affected, (left- or right-sided failure), or by the cardiac cycle involved, (systolic or diastolic dysfunction). (Schilling-McCann p. 176). The word "failure" refers to the heart's inability to pump enough blood to meet the body's metabolic needs. (Schilling-McCann p. 176). When the heart fails to deliver adequate blood supply edema may develop. (Cadwallader p. 1141). Where edema occurs depends on what side of the heart is failing.

The most common manifestation is chest pain (70% to 90%). Less common symptoms includes; dyspnea (20%) and pulmonary edema may be present. Acute heart failure, cardiogenic shock, and cardiac arrhythmias are uncommon.(9,10) About one third of patients with TCM have ECG

Left sided heart failure occurs as a result of ineffective left ventricular contractile function. As the pumping ability of the left ventricle fails, cardiac output falls. Blood is no longer effectively pumped out into the body; it backs up into the left atrium and the into the lungs, causing pulmonary congestion, dyspnea, and activity intolerance. If the condition persists, pulmonary edema and right

Apical hypertrophic cardiomyopathy is a disease that mainly affects the apex of the heart and does not cause any obstruction. [1] These abnormalities in the heart muscle can cause a wide variety of symptoms. As the heart becomes stiff it increases the pressure in the left ventricle which can push blood back into the lungs, causing shortness of breath in exercise. Chest pain can occur as there is not enough oxygen available to the cardiac muscle due to insufficient blood supply. Palpitations and lightheadedness, along with other conditions can occur as a result of HCM. In addition to these discomforting symptoms, the patient may develop an arrhythmias that often goes unnoticed. An arrhythmia takes place as the electrical conduction of the heart is disturbed by the abnormal scattering of myocytes. The two most common arrhythmias are atrial fibrillation causing palpitations, and ventricular tachycardia that can be life threatening causing sudden death. Both conditions can be controlled with medication. [4]

A diagnosis may start with routine bloodwork to rule out non cardiac conditions that could be triggering tachycardia. A chest x-ray may also be performed to see if there is any cardiomegaly present. In my case, and in most cases, it starts with a 12 lead ECG. According to Ellis and Rottman (Dec. 04, 2015) “the classic ECG features are as follows:

Wolff-Parkinson-White syndrome (WPW) is a conduction disorder of the heart that is caused by pre accessory pathway resulting in tachyarrhythmias. Kesler & Lahham (2016) state, “Approximately 0.07% of the population often presents with the chief complaint of palpitations”. A diagnosis of WPW is made in conjunction with certain characteristics. Characteristics of WPW include: a short PR interval < 0.12 second caused by a faster electrical conduction through the accessory pathway than the atrioventricular node, upsloping of the QRS and a delta wave. The delta wave is indicative of rapid ventricular depolarization caused by the rapid conduction through the accessory pathway (Kesler & Lahham, 2016, p. 469).

Hypertrophic cardiomyopathy is characterized by interventricular septal hypertrophy (in absence of other cardiovascular conditions), causing decrease of left ventricle cavity and potentially leading to outflow obstruction. (1) (6) As a consequence of mutations in several genes encoding for thick and thin filaments which build the cardiac muscle, morphological changes occur leading to tangled, thickened myocardial fibers. It is an important cause of morbidity and mortality. Symptomatology varies a lot, from asymptomatic patients to those with severe cardiac function impairment. Some of the most common symptoms of HCM, which are not specific to this disorder may be: shortness of breath at rest or with exertion, fatigue, chest pain, arrhythmias, dizziness, but not only.

Resting ECGs are usually normal in myocardial ischemia. Ischemic changes may be noted only during period of actual chest pain. ECGs also show abnormal

Hypoplastic left heart syndrome is characterized by hypoplasia of the left ventricle, aortic stenosis, hypoplasia of the ascending aorta, and coarctation (narrowing) of the aorta. In normal conditions the left side of the heart receives oxygenated blood from the lungs and pumps it into the systemic circulation. In patients with HLHS, the left ventricle and the aorta are underdeveloped. The

Blood tests will be done to assess troponin I, troponin T, creatine kinase (CK) and myoglobin which are classified as cardiac serum markers (Cardiac Emergencies, n.d.).

Based on the laboratory test, electrocardiogram, and the patient’s presentation would lead the health care provider to believe that the patient is having a myocardial infarction or heart attack. A myocardial infarction is when suffienct blood flow to the coronary arteries is decreased or stopped which in turn leads to partial or complete failure of the cardiac muscles in that area of the heart (Abreu de Vargas, Riegel, de Oliverira Junior, Silveira Siqueira, & Oliveira Crossetti, 2017, p. 2804). When the cardiac muscle is not getting the blood flow and the oxygen that it needs the tissues start to become necrotic and release a chemical called troponin. A laboratory test that is performed on patient that complains of chest pain is a troponin,