Symptoms And Treatment Of Chest Pain

A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he

Mr. Thomas’ has been diagnosed with an acute myocardial infarction (MI). A myocardial infarction is an “infarct of heart muscle caused by occlusion of one or more of coronary arteries” (Frucht, 2012 P.125). The common name for Mr. Thomas’ condition is a heart attack. A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked ( ). If the blood flow is not restored quickly, then that section of the heart muscle begins to die. Heart attacks have become the leading killer of both men and women in the United States. The main cause of heart attacks has

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.

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

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).

43 percent of alarm conditions indicated non-critical, and “generally non-actionable,” events; 38 percent of alarm conditions indicated premature ventricular complexes (PVCs), which, since a landmark 1988 Cardiac Arrhythmic Suppression Trial (CAST) study, are no longer treated; and 3.6 percent of alarm

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

Data gathered tonight includes electrocardiogram is unchanged from previous showing slightly low voltage, left anterior fascicular block. No definite ischemic changes. White count of 6.2, hemoglobin 11.00, platelets 117, glucose 90, BUN 43, creatinine 2.56, sodium of 138, potassium of 3.4, chloride 106, CO2 of 24.8, calcium of 8.2, bilirubin 0.92, alkaline phosphatase 307, ALT of 23, AST of 21, magnesium of 1.8, a troponin is 0.06, BNP is 2650. Labs done almost 24 hours ago had a lower BUN at 41, and a lower creatinine 2.23, a higher potassium at 3.7, BNP that was higher earlier at 3350, and a troponin that was slightly less at 0.04. Chest x-ray may have more congestion now than previous. Frontal view this morning was obtained the radiologist says the findings are concerning for minimal congestion versus atelectasis in lung bases and a stable mild to moderate cardiac

Supraventricular tachycardia is increase in heart rate over 150 bpm due to do the over firing or redirected firing of the SA Node conduction above the ventricles. With supraventricular tachycardia the patient can have an abrupt onset and termination of rhythm, flattened or retrograde conduction P waves and narrow QRS waves specifically less than 0.08 second (Kyle, 2012).

Acute coronary syndrome encompasses patients diagnosed with unstable angina, non-ST elevation myocardial infarction, and ST-elevation myocardial infarction (Amsterdam et al., 2014). Per the American College of Cardiology (2014), a rapid evaluation to identify life-threatening cardiac conditions is imperative for patients presenting to emergency departments with symptoms of acute coronary syndrome and an electrocardiogram is an essential tool for diagnosis (Amsterdam et al., 2014). Patients with ST-elevation myocardial infarction have a 7.4% increase in risk of mortality with every half-hour that passes before implementing appropriate reperfusion therapy (Omar, Helal, Mangar,

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.

Even though no pathophysiological method has been associated with the Takotsubo cardiomyopathy, broad research has been done in relation to the perfect way of diagnosing this syndrome. The theory that has been accepted by the majority of researchers is the catecholamine theory, which occurs as an impact of excess activation of the sympathetic nervous system. Other theories that have been developed over time include ischemia, which resulted from multi-vessel coronary spasm alternatively of the transient atherosclerotic plaque. The first theory that explains in depth the main causes of TTS (Takotsubo cardiomyopathy) is multi-vessel coronary spasm. Coronary spasm that causes ischemia even when an obstructive coronary artery condition is absent,

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.).