This Is the first case study that Is required for the class. Please submit a paper (doesn’t have to be long; you could even give me bullet-point answers to the questions listed below) that answers all of the questions posed after Case Study 1. I have included an easy second case study which, if you complete it, will be worth extra credit. Answers to the first Case Study are worth 25 points and responding to Case Study 1 is required work for the course. The extra credit, which is not required, will be worth a total of 10 points. Both are due at the beginning of class on Tuesday, February 17, 2015.

Case 1 A. O. Is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular Infarct when she was In her sys. She had poor activity tolerance and required assistance with actively of dally living. Even minimal actively was associated with moderately severe dispense and exertion chest pain, which was relieved by rest. A. O. Also exhibited marked pedal edema bilaterally. She Is being treated with digitalis, fireside (Lasts), KICK, and subliminal nitroglycerin. Discussion Questions . Which type of heart failure (left or right sided) is usually associated with dispense?

What other clinical findings are likely to be present with left-sided heart failure? 2. What compensatory mechanisms are likely to be operative in A. O. To enhance cardiac output? 3. What is the most likely cause of A. O. ‘s pedal edema? 4. What is the cause of A. O. ‘s exertion chest pain? What laboratory tests would be useful to confirm this diagnosis? 5. What Is the rationale for the use of each of A. O. ‘s medications In managing her heart disease? 1 . -Left sided heart failure on the backwards effect. Orthogonal, cough, occasions, basilar crackles 2. SANS activation, Increased preloaded, myocardial hypertrophy 3. – since the left side of the heart is unable to pump properly, the highway of blood is not circulating throughout the body and since the feet are the furthest away from the heart, the blood pools and causes edema. 4. 5. -telltales – Increases SF and ejection fraction therefore Increasing CO. Improves systemic circulation. Fireside – prevents the body from absorbing too much therefore less chance for edema -KICK – Helps increase the already diminished mount of KICK in the body that helps with contraction and relaxation of the heart. Nitroglycerine – vacillator that helps blood flow better K. R. Is a 46-year-old man admitted to the emergency department with unremitting chest discomfort. The pain started while he was swiveling snow from his walkway. He had experienced chest discomfort with activity previously, but the pain had subsided with rest and he sought no medical help. This time the pain did not subside and became increasingly severe, radiating to his left arm and lower Jaw. In the emergency apartment, an EGG and cardiac enzymes were obtained.

The cardiac monitor showed sinus tachycardia with occasional premature ventricular complexes. K. R. Was treated with 2 L nasal oxygen, thrombosis therapy, subliminal nitroglycerin, and IV morphine sulfate. When he was pain free, he was transferred to the cardiac unit for monitoring. 1 . What electrocardiograph changes would indicate that K. R. Has acute coronary syndrome (ACS)? 2. What changes in “cardiac enzymes” would be consistent with a diagnosis of MI? 3. What is the most common pathologically precipitating event for ACS?

What differentiates USA from MI? 4. What is the rationale for using thrombosis in the management of STEM’? 5. Why are morphine and nitroglycerin used to manage chemic chest pain? 1. Large Q wave, SST elevation, and inverted T wave 2. Decrease in K, CLC, and An 3. Complete occlusion. USA has a lot of MI’s compared to other countries? 4. They break down the occlusive thrombus in the lumen 5. Morphine because it increases vascular capacity and reduces resistance so less 02 is needed. Nitroglycerine because it relieves chest discomfort, and thrombosis.

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