S. D Case Study

ECG : ventricular rate 54 beats/min, HR varying from 39 to 60 during a 45 minute period of monitoring, infrequent PVCs, ST elevation in leads II, III and avF indicating inferior injury or ischemia secondary to acute MI.

You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

This case study discusses the management of a 68 year old male who presented with chest palpitations secondary to rapid atrial fibrillation. Atrial fibrillation is a common cardiac arrhythmia with serious complications if not treated correctly. This essay will discuss the initial clinical presentation of the patient and examine the management and outcome of the interventions applied. The significance of atrial fibrillation including its pathophysiology and aetiology will also be discussed.

Serious causes for chest pain include: Acute Coronary Syndromes (ACS): New onset angina, accelerating or crescendo angina and prolonged angina or coronary insufficiency, non ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI). The typical features of cardiac chest pain are 1.) located under the breastbone or at least some of the pain is situated in this area, 2.) other features include provocation by exercise or stress and 3.) relief by rest or nitroglycerin. If all three features are present the patient is

A common symptom for myocardial ischaemia is angina - chest pain. Angina can occur in two forms: stable or variant angina (McCance & Huether, 2014, pg. 1154). Stable angina is caused by myocardial ischaemia. The symptoms are usually described as sensation of heaviness, pressing or squeezing pain, and sometimes may radiate to other places such as left shoulder, arm, lower jaw and neck (McCance & Huether, 2014, pg. 1154; Touhy, Jett, Ebersole, & Hess, 2012, pg. 270). On the other hand,

Cardiac: Mrs. Elliot states she has experienced chest pain 5-6 times starting three weeks ago when she is Short of breath. The pain she said is on the left side of chest and describes is as sore and uncomfortable. Additionally, the patient has experienced palpitations the past few weeks and is positive for peripheral edema. Denies redness, cyanosis, jaundice, flushing.

At this point, we do not know exactly what are the settings, we have previous requested pacemaker operative report from Regions. Unfortunately, from what he is telling today, his date of the birth was not correct as such dose report were not same. He noted that he thinks he came back from the hospital, he has not had similar complaint or concern or report of chest pain. It should be noted that hospital records, with a troponin that was negative, 12-lead EKG was similar to the one that was obtained here, essentially identifying sinus bradycardia with first-degree AV block, left ventricular hypertrophy with repolarization abnormality. QT was prolonged, similar EKG obtained at facility also identified pretty much the same abnormality pattern. Troponin was negative. Other workup included chest x-ray in the hospital were all unremarkable. Today he is not reporting any chest pain, no shortness of breath, no nausea or emesis. He has got healed ____ scar to the left chest from pacemaker implantation which is completely healed but slightly

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia noted. No edema noted in extremities. Patient skin is cool to touch, slightly clammy. EEG shows prolonged QRS wave, with ischemic ST changes and PVCs. Chest radiograph clear.

Atrial fibrillation (AF) is a cardiac arrhythmia. It is the most common arrhythmia and it has implications for patients and anaesthetists alike. The anaesthetist must take into consideration the physiological and pharmacological implications of this common arrhythmia.

Cardiac dysrhythmias come in different degrees of severity. There are heart conditions that you are able to live with and manage on a daily basis and those that require immediate attention. Atrial Fibrillation is one of the more frequently seen types of dysrhythmias (NIH, 2011). The best way to diagnosis a heart condition is by reading a cardiac strip (Ignatavicius &Workman, 2013). Cardiac strips play an chief part in the nursing world allowing the nurse and other trained medical professionals to interpret what the heart is doing. In a normal strip, one can clearly identify a P wave before every QRS complex, which is then followed by a T wave; in Atrial Fibrillation, the Sinoatrial node fires irregularly causing there to be no clear P

Table 2. This table shows the recording of the amplitude, period, and BPMs for the ventricular contractions before and the effects of the Warm Ringer’s after.

Collaborate with your preceptor to interpret your patient’s EKG rhythm and list your patient’s rhythm.  Discuss the implications this patient’s heart rhythm has for circulation.   How does your patient’s specific rhythm impact the physical assessment findings?  What if the rhythm changes:  what would happen if the rhythm became slow, fast, or irregular?  How could these changes manifest in the patient assessment and how would you, as the nurse, proceed?

Electrodes must be placed in the correct landmarks to prevent misinterpretation of the ECG. If the electrodes are placed incorrectly, the ECG may read as ST changes, electrical axis, location of bundle branch blocks and location of infarcts (Riddle, 2008, para. 5). During the ECG, a total of 10 electrodes are applied to the patient. Six electrodes (V1-V6) are placed on the anterior chest in the proper anatomical landmarks, and these leads must be placed precisely for an accurate ECG interpretation. Electrodes V1 and V2 are placed on the fourth intercostal space with V1 on the right and V2 on the left (Riddle, 2008). Electrodes V3-V6 are placed on the left chest wall on the fifth intercostal space in the following order: V3 to the right of V4, V4 at the midclavicular line, V5 to the right of V6, V6 to the midaxillary line (Riddle, 2008). The remaining four electrodes are placed on both upper and lower extremities without touching the chest.

Atrial fibrillation (AF) is the most common sustained heart rhythm disturbance in the United States, affecting over 2 million individuals with over 150,000 new cases of AF being diagnosed each year. Approximately 4% of the population over the age of 65 is affected. As a person ages,

7.ECG: To see the evidence of ischemic changes, cardiomegaly suggestive of heart failure or evidence of left ventricular hypertrophy.