S. D Case Study

The ECG is a test that connects wires to the chest and arms displaying the electrical signals of the heart on a monitor. In atrial fibrillation, the monitor will display no discernable, independent P waves, but rather replaced by evident F waves. The QRS complex will vary with R-R intervals and result in a rapid, narrow complex (Goralnick, 2015). The ECG can also provide other information such as presence of bundle-branch block, left ventricle hypertrophy, and prior myocardial infraction (Floyd, 2016). The holter monitor is a portable ECG that is carried around and records 24 hours or more of heart activity to later be interrupted by the doctor. The event recorder is again the portable ECG that is intended to record weeks to months of heart activity and records only if an episode of atrial fibrillation occurs. The echocardiogram is a noninvasive test that shows a video image of the heart originated by sound waves. These images can show if there is any structural damage of the heart. Blood tests are completed to eliminate thyroid issues or other biomarkers in the blood that could be causing the atrial fibrillation (Mayo Clinical Staff, 2015). Positive biomarker results are elevated C-reactive protein and B-type natriuretic peptide

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.

12 Lead Electrocardiogram (ECG) - There are typical changes to the normal pattern of the ECG in a heart attack. Patterns that occur include pathological Q waves and ST elevation (Koutoukidis, Stainton & Hughson 2013, p. 505). However, it is possible to have a normal ECG even if a patient has had a heart attack. The indicators for this test include: suspected myocardial infarction, suspected pulmonary embolism, perceived cardiac dysrhythmias, fainting or collapse, a third heart sound, fourth heart sound, a cardiac murmur or other findings to indicate structural heart disease. The

On arrival at the ED, the physician auscultates muffled heart tones, no breath sounds on the right, and faint sounds on the left. A.W. is

Mr. S was driving when he experience a stabbing chest and back pain for the first time. The pain was so severe he immediately went to his local ER. Pulmonary ventilation and perfusion (VQ) scan and Computed tomography angiography (CTA) was done at his local ER. VQ scan was negative for pulmonary embolism (PE). CTA of the chest revealed

Parker included collecting cues in 12-lead ECG, blood pressure, potassium level, sodium level, the warmth of hands and feet and pain score (Corrales-Medina et al., 2012). Also, the process involved identifying the risk factors associated with the patient's condition. From the immediate assessment, it included weight, smoking history, history of depression and family history of cardiac conditions (Corrales-Medina et al., 2012). One evening, Mr. Parker slumped on the bed; I monitored the continuous cardiac monitor to determine his heart rhythm. Based on current information, the T wave on the ECG indicated that the ventricles are repolarising (Levett-Jones et al., 2010).

Patients experiencing chest pain require immediate assessment, including a twelve lead ECG within the time frame of ten minutes, will provide vital evidence of a cardiac, plueretic or musculoskeletal event (Acute Coronary Care Clinical care standards 2014).

Each of these monitors is designed to alarm nursing staff whenever a drastic change has occurred with a patient’s condition. For example, if a patient’s heart rate drops below sixty beats per minute then an alarm will sound to alert the nurse that the patient has become bradycardic. These alarms are intended to protect the patient from harm and ensure that they receive timely interventions from nursing staff and physicians (AAMI, 2011).

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

In the evaluation of patients with chest pain, the preliminary ECG is a more clear-cut tool for early risk stratification with more recent recommendations indicating that ECG should be performed as early as possible, within 10 minutes of ED admittance. Early indicators associated with MI or ischemic complication such as ST segment elevation or depression allows rapid treatment aligning with the indicated complication. While the ECG may reveal significant indicators in certain situations, in other circumstances findings may be limited due to low diagnostic sensitivity

This report is an analysis of an anonymous patient’s medications and how they relate to his health issues. Please note that the patient will be referred to as patient Afib in order to protect his privacy. Patient Afib is a 58 year old male with a recent onset of atrial fibrillation (AF) that has been cured using ablation and antiarrhythmic medications. This report discusses how physicians treated patient Afib’s AF, the medications patient Afib is currently taking and their mechanism of action, and how these medications relate to the patient’s disease. Medications discussed in this analysis include Proair HFA, Multaq, Toprol XL, and Coumadin. Proair HFA, a rescue inhaler used to treat asthma, was prescribed to patient Afib in order to determine if AF or underlying asthma caused his shortness of breath. Multaq is an antiarrhythmic drug used to keep patient Afib in a normal sinus rhythm. Toprol XL is a medication used in the treatment of hypertension that also exhibits rate controlling properties which prove beneficial for patient Afib. Coumadin, an anticoagulant, is used to reduce the risk of stroke for patient Afib should his AF ever spontaneously return without his knowledge. Patient Afib does not like the regime of pills he is required to take but understands their necessity.

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.

There are three types of atrial fibrillation. The first type is paroxysmal atrial fibrillation. It will occur at random time and stop by its own. This type of AF would normally stop within one week and it does not require any treatment. It will normally cause the most symptoms in people who has it as it is so unpredictable and

Once at the hospital tests will be done to rule out other chest pain related causes. The first test that will be done is an Electrocardiogram or an EKG, which records the hearts electrical activity. Damaged heart cells are not able to produce electrical impulses which will produce abnormal EKG results. Elevations in the ST waves on an EKG are classified STEMI and are present in over ninety percent of myocardial infarctions who had a complete occlusion to an artery (Cardiac Emergencies, n.d.). NSTEMI is where there is no elevation of the ST wave and is indicative that a full occlusion has not occurred (Cardiac Emergencies, n.d.).

Finally, ensure that the patient is supine on a bed, comfortable and relaxed. Cowley (2002) describes how accurate chest lead placement is essential for ensuring quality ECG output, as any misplaced leads may result in a change in ECG waveform, in turn this may cause the ECG trace to be misinterpreted. The full pictorial description