The goal of medical management is to minimized myocardial damage, preserve myocardial function, and prevent complications. These goals are achieved by reperfusing the area by emergency use of Percutaneous Transluminal Coronary Angioplasty (PTCA) or thrombolytic medication. Minimizing myocardial damage is also accomplished by reducing myocardial oxygen demand and increasing oxygen supply with medications, oxygen administration, and bed rest.
Cardiogenic shock, according to Werden et al. (2012), is the most common cause of death from an acute myocardial infarction (AMI) and has a chance of mortality from thirty percent to eighty percent. Infarction-related cardiogenic shock (ICS) complicates approximately five to ten percent of acute myocardial infarctions (AMI) and remains the leading cause of death in patients hospitalized from an AMI (Kolte et al., 2014). Kolte et al. (2014) also states that the incidence of cardiogenic shock is higher in patients over the age of seventy-five, and has higher prevalence in women, Caucasians, Asians, and Pacific islanders. This paper will discuss the pathophysiology, clinical manifestations, tools used to diagnose, and therapeutic management of cardiogenic shock.
Once occluded, these arteries cannot deliver oxygenated blood to the cardiac tissues, which leads to cardiac ischemia and infarction. The death of cardiac muscle can be so great that it is fatal, or it can be within a spectrum of morbidity that limits an individual’s ability to perform activities of daily life and decreases one’s quality of life. CHD is prevented by healthy habits, such as good nutritional intake, a minimum of 150 minutes of moderate physical activity per week, stress management, and consistent screenings (LCMHS, 2016). These interventions can also be used during any stage of the disease, for they can reduce the progression of the disease as well as improve the effectiveness of medications and other provider-ordered
1). Chest X-ray was normal. Initial laboratory studies were remarkable for white blood cells count of 12.1K, a creatine kinase MB fraction of < 3 mm was associated with significant reductions in restenosis and the rate of target vessel revascularization19. In SES-SMART trial patients were randomly assigned to receive a Sirolimus-eluting or bare-metal stent in small coronary artery. Sirolimus stent was associated with significant reductions in the rates of angiographic restenosis (primary outcome), target lesion revascularization and MI at 8 months20. The composite clinical endpoint ( death, non-fatal MI, ischemia- driven target lesion revascularization, and cerebrovascular accidents) was significantly lower with the sirolimus-eluting stent21. In the TAXUS V trial, in the subset of patients with small coronary arteries, the paclitaxel stent was associated with significant reductions in angiographic restenosis and target lesion revascularization at nine months compared to bare metal stents22. Although DES improves target lesion revascularization rates compared to bare-metal stents in small vessels, the absolute rates are still higher in small vessels than large
A 32-year old nurse who has rheumatic fever as a child noticed a persistent tachycardia and light-headedness. Upon examination, chest x rays showed an enlarged left atrium and left ventricle. ECG analysis showed atrial fibrillation. There was also mild pulmonary congestion. Cardiac evaluation resulted in the following information:
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
Next we have Cardiac tamponade [which is caused by blunt or penetrating trauma or a few medical conditions such as cancer or autoimmune dieses] which is a serious condition where the blood accumulates in the pericardial sac [the sack around the heart]. While there is no definitive treatment on a basic level and ALS provider can relieve fluid with a needle in a risky but necessary procedure the last form of cardiogenic shock is a pulmonary embolism. A pulmonary embolism is when there is a blood clot blocking the flow of the pulmonary veins leading to obstructive shock and causing heart failure. Interesting enough to mention is the fact that one of the more common causes to cardiogenic shock is damage to the heart muscle however just because you have a heart attack does not necessarily mean you have had caridogenic
Diagnostic test would include, CBC with differential, ESR, platelet count, CRP, liver transaminases, gamma-glutamyltransferase (GGT), and urinalysis. CRP will be elevated but ESR is sometime normal. Blood, urine, cerebrospinal fluid, and group A beta-hemolytic streptococcus pharyngeal cultures may be collected to identify other sources of fever. Diagnostic test would be done to confirm or rule out the diagnosis of Kawasaki disease (Burns, Dunn, Brady, Starr & Blosser, 2013).
Coronary artery disease remains number one killer of the western civilization despite 40 years of aggressive drug and surgical interventions (Esselstyn). Usually, pharmaceutical drugs, such as statin, are given to try to slow the progression, but may provide uncomfortable side effects. In fact, the majority of patients discontinue statins within 1 year of treatment initiation (Maningat). Furthermore, surgery is performed to circumvent clogged arteries and literally bypass the symptoms. In the last year, 500,000 coronary bypass procedures were performed (Swaminathan et al). However, these surgeries can have significant risks, including the potential to cause further heart damage, stroke, and brain dysfunction. Thus, it is evident that these way of treatments may not be enough on its own, and that getting to the
This is a contagious bacterial disease that is transmitted through the air(respiratory) or by person-to-person contact, and is often accompanied by fever and delirium, headache, weakness, and cough. If not treated early enough, the recipient may go into septic shock and die. Antibiotics are effective in the treatment of this type of disease.
One of the patient’s secondary diagnoses is atherosclerotic heart disease of native coronary artery without angina pectoris. He had a heart valve replacement in 2011. Atherosclerosis is a disease in which plaque made of fat, cholesterol, calcium, and other substances builds up inside the arteries. This is an issue because the plaque hardens over time and narrows the arteries, which then limits the flow of oxygenated blood to vital tissues. This condition can lead to heart attacks, strokes, and death. Coronary artery atherosclerosis is the single largest killer of both men and women in the United States (Boudi, 2016). The patient’s atherosclerosis is located in the coronary artery. This artery is one of two main blood vessels that branch off
Our body system is not immune to pathological deficiencies. There exist numerous identified pathologies which compromise the regular functioning of a heart, but all heart-related pathologies are narrowed to a single condition known as Acute Coronary Syndrome (ACS). This is the term properly used in reference to the different identified clinical entities threatening the cardiovascular system. ACS is the result of the progressive or complete sudden blocking of the arteries or veins; this prevents an appropriate blood flow through the circulatory system, and as a consequence, the body is unable to receive enough oxygen and nutrients to meet its daily necessities.
Current Treatment and Consideration of Evidence Base: Upon admission, patient was most-likely suspected of having ACS (acute coronary syndrome) because of CHD (coronary heart disease) (NICE, 2014c). Troponin T High Sensitivity Test was carried out to distinguish whether chest pains were because of NSTEMI or unstable angina (NICE, 2014b). This led to diagnosis of unstable angina. His current treatment with regards to drug interactions is okay, except that enoxaparin has a clinically significant interaction with aspirin (2015, p. 1199). This can be discounted for due to his condition.
The patient will need to be hospitalized for immediate treatment to prevent coronary disease, as the disease can cause heart disease (Starkebaum, 2015). Treatments will include intravenous gamma globulin along with aspirin. Most children will recover from the disease. However, some children will die from heart disease secondary to the Kawasaki disease; therefore the child should have an echocardiogram every 1 to 2 years to assess for coronary artery disease (Starkebaum, 2015). The parents will be advised to call their health care provider if the child experiences recurrent symptoms of swelling and redness in the palms, reddened eyes, and high fever that does not resolve with
A recent systematic review of observational data (6 studies) found that the total mortality rate in angina patients was 2.8% to 6.6% per annum(121). At present it is thought that stable angina does not cause permanent myocardial damage. However prompt diagnosis and treatment is important to prevent further complications. Initiation of pharmacological intervention has been shown to retard plaque disease progression and to stabilise the surface endothelium(131).