...Cardiovascular Case Study Mr. Smith is a 56-year-old Caucasian man who is being evaluated in the emergency room with progressively worsening chest pain that began 2 hours ago. The patient describes the pain as pressure in the center of his chest. He rates his pain 7/10. He reports the pain is now radiating down his left arm and through to his back, he is diaphoretic, and complaining of shortness of breath. He denies nausea or vomiting. Mr. Smith reports no previous history of chest pain or pressure. He smoked one pack of cigarettes daily for 13 years but quit smoking last year. He denies a family history of heart disease. Upon initial examination he did not have jugular venous distension, no carotid bruits, normal S1 and S2 with an S3 present. No S4 or murmurs auscultated. Lung sounds clear to auscultation bilaterally, bowel sounds normal, all pulses palpable 2+/4, no edema present. Diagnostic data: BP: 165/98 mmHG HR: 96 bpm RR: 30 breaths/min Temp: 37 C SaO2: 96% with 2L/min O2 per nasal cannula Wt:100 kg A 12-lead ECG was performed in the emergency room showed: Normal Sinus Rhythm (NSR) with frequent premature ventricular contractions. ST segment elevation in Leads 1, aVL, and V2 through V6 (3mm). ST segment depression in Leads III and aVF. Q waves in V2 through V4. The chest X-ray revealed slight cardiomegaly with mild congestive heart failure. An echocardiogram reveals an ejection fraction of 30% and mild mitral valve regurgitation. Mr. Smith’s...
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...Aldosterone: Role in Edematous Disorders, Hypertension, Chronic Renal Failure, and Metabolic Syndrome. Schrier RW, Masoumi A, Elhassan E. University of Colorado Denver, Aurora, Colorado. Abstract The role of aldosterone has expanded from the hormone's genomic effects that involve renal sodium transport to nongenomic effects that are independent of the effect of aldosterone on sodium transport. The nongenomic effects of aldosterone to increase fibrosis, collagen deposition, inflammation, and remodeling of the heart and blood vessels, however, are markedly increased in the presence of high sodium intake. The genomic effect of aldosterone increases renal sodium transport, but the administration of large doses of aldosterone to normal individuals does not cause edema, relating to the phenomenon of "aldosterone escape"; however, in edematous disorders including cardiac failure, cirrhosis, and nephrotic syndrome, impaired aldosterone escape leads to renal sodium retention and edema formation. There is now considerable evidence for the nongenomic effects of aldosterone in several important diseases. Thus, low dosages of mineralocorticoid antagonists, with little or no effect on urinary sodium excretion, have been shown to afford a beneficial effect on morbidity and mortality in patients with advanced cardiac failure and after acute myocardial infarction. Three-drug-resistant hypertension has also been found to respond to spironolactone in modest dosages. The combination of an...
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...Title of the article: Intractable hyperkalemia due to Nicorandil induced potassium channel syndrome Abstract: Nicorandil is a commonly used antianginal agent which has both nitrate-like and ATP-sensitive potassium channel activator properties. Activation of potassium channels by nicorandil causes expulsion of potassium ions into the extracellular space leading to membrane hyperpolarisation, closure of voltage-gated calcium channels and finally vasodilatation. However, on the other hand, being an activator of ATP sensitive potassium channel, it can expel K+ ions out of the cells and can cause hyperkalemia. Here, we report a case of nicorandil induced hyperkalemia unresponsive to medical treatment in a patient with diabetic nephropathy. Key-words: Nicorandil, Hyperkalemia, ATP-sensitive potassium channels, Channelopathy. Introduction: Nicorandil is an arterial and vanodilator having cardioprotective properties via activation of ATP-sensitive potassium channels. It is used as an antianginal agent and coronary...
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...Coronary Artery Disease. Coronary artery disease is the narrowing or blockage of the coronary arteries, usually caused by atherosclerosis. Atherosclerosis (sometimes called “hardening” or “clogging” of the arteries) is the buildup of cholesterol and fatty deposits (called plaques) on the inner walls of the arteries. These plaques can restrict blood flow to the heart muscle by physically clogging the artery or by causing abnormal artery tone and function. Without an adequate blood supply, the heart becomes starved of oxygen and the vital nutrients it needs to work properly. This can cause chest pain called angina. If blood supply to a portion of the heart muscle is cut off entirely, or if the energy demands of the heart become much greater than its blood supply, a heart attack (injury to the heart muscle) may occur. Your coronary arteries are shaped like hollow tubes through which blood can flow freely. The muscular walls of the coronary arteries are normally smooth and elastic and are lined with a layer of cells called the endothelium. The endothelium provides a physical barrier between the blood stream and the coronary artery walls, while regulating the function of the artery by releasing chemical signals in response to various stimuli. Coronary artery disease starts when you are very young. Before your teen years, the blood vessel walls begin to show streaks of fat. As you get older, the fat builds up, causing slight injury to your blood vessel walls. Other substances traveling...
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...Fiction? Gunver S. Kienle* and Helmut Kiene ¨ Institut fur Angewandte Erkenntnistheorie und Medizinische Methodologie, D-79112 Freiburg, Germany ABSTRACT. In 1955, Henry K. Beecher published the classic work entitled ‘‘The Powerful Placebo.’’ Since that time, 40 years ago, the placebo effect has been considered a scientific fact. Beecher was the first scientist to quantify the placebo effect. He claimed that in 15 trials with different diseases, 35% of 1082 patients were satisfactorily relieved by a placebo alone. This publication is still the most frequently cited placebo reference. Recently Beecher’s article was reanalyzed with surprising results: In contrast to his claim, no evidence was found of any placebo effect in any of the studies cited by him. There were many other factors that could account for the reported improvements in patients in these trials, but most likely there was no placebo effect whatsoever. False impressions of placebo effects can be produced in various ways. Spontaneous improvement, fluctuation of symptoms, regression to the mean, additional treatment, conditional switching of placebo treatment, scaling bias, irrelevant response variables, answers of politeness, experimental subordination, conditioned answers, neurotic or psychotic misjudgment, psychosomatic phenomena, misquotation, etc. These factors are still prevalent in modern placebo literature. The placebo topic seems to invite sloppy methodological thinking. Therefore awareness of Beecher’s...
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...by Roland Sturm ABSTRACT: This paper compares the effects of obesity, overweight, smoking, and problem drinking on health care use and health status based on national survey data. Obesity has roughly the same association with chronic health conditions as does twenty years’ aging; this greatly exceeds the associations of smoking or problem drinking. Utilization effects mirrors the health effects. Obesity is associated with a 36 percent increase in inpatient and outpatient spending and a 77 percent increase in medications, compared with a 21 percent increase in inpatient and outpatient spending and a 28 percent increase in medications for current smokers and smaller effects for problem drinkers. Nevertheless, the latter two groups have received more consistent attention in recent decades in clinical practice and public health policy. M a n y b e h a v i o r a l r i s k f a c t o r s , chief among them smoking, heavy drinking, and obesity, are known causes of chronic health conditions. Chronic health conditions, like cancer, diabetes, or heart disease, in turn are primary drivers of health care spending, disability, and death. This paper compares the associations of smoking, problem drinking, and obesity with health care use and chronic conditions. All three risk factors are prevalent, although only obesity has dramatically increased over the past twenty-five years. There is an extensive literature of the association of individual risk factors with selected...
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...Coronary Heat Disease Health 11 LATTC 11/20/10 Coronary Heart Disease, chronic illness in which the coronary arteries, the vessels that supply oxygen-carrying blood to the heart, become narrowed and unable to carry a normal amount of blood. Most often, the coronary arteries become narrowed because of atherosclerosis, a process in which fatty deposits called plaque build up on the inside wall of an artery (see Arteriosclerosis). Plaque is made of oily molecules known as cholesterol, fibrous proteins, calcium deposits, tiny blood cells known as platelets, and debris from dead cells. Plaque formation often begins in adolescence and progresses very slowly over the course of decades. Gradually, the growing plaque thickens the wall of the artery, reducing the space for blood to flow through. According to the American Heart Association, in 2009 heart disease affected people as follows: • A person’s death occurs every 34 seconds due to heart disease in the United States. • In the US a person dies of heart attack every 20 seconds. • About 2,500 American die due to heart attacks. • Around 250,000 die due to heart attack before they reach a hospital in the US. • Those below the average level of education suffer from heart attacks more. • The following countries are known for higher death rates due to heart disease. Romania, Bulgaria, Poland, Czechoslovakia, Hungary and the Soviet Union. • About 6 million hospitalizations take place each year in the US on account of cardiovascular...
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...Advanced Nursing Practice I NSG6001 Genitourinary Care Plan Case Genitourinary Care Plan Patient Initials: H.M Age: 60 years old Sex: Male Subjective Data: Client Complaints: Decreased Urinary flow, dysuria, nocturia, urinary frequency, low grade fever. HPI (History of Present Illness): This 60 year old Hispanic male presents at the clinic today with a chief complaint of urinary frequency, decreased urine flow, increased nocturia, slight terminal dysuria and low grade fever. The patient was experiencing these symptoms for the past two years, but they had increased a whole lot more during the last two weeks. Upon assessment, it is noted that the patient has a systolic murmur that is more audible at the right sternal border. Five years ago, patient was in the hospital with suspected angina. At the moment, the patient presented with a PSA level of 6.0. In the past patient did not seek medical advice or treatment for his symptoms which have worsening now and forced him to look for medical assistance. PMH (Past Medical History—include current medications, any known allergies, any history of surgery or hospitalizations): Patient has history of urinary frequency, decreased urine flow, nocturia and dysuria which he did not seek medical help for. Patient was hospitalized five years ago, where he was treated for chest wall syndrome. Patient is currently under treatment for high cholesterol and hypertension...
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...in other tissues. If there is only a single plasma cell tumor, it is called an isolated or solitary plasmacytoma. When there is more than one plasma cell tumor, it is called multiple myeloma. In the United States , the risk of getting multiple myeloma is 1 in 149% (0.67%). The American Cancer Society estimates in 2013: About 22,350 new cases will be diagnosed (12,440 men and 9,910 women). About 10,710 deaths will occur (6,070 men and 4,640 women). (https://www.cancer.org/cancer/multiplemyeloma/detailsguide/multiple-myeloma-key-statistics.) Most people who develop multiple myeloma have no clear risk factors: However some risk factors have been identified. Risk factors concerning multiple myeloma included: age, gender, race, obesity, employment in the petroleum industry and exposure to radiation. Most first diagnosis is usually seen in patient’s in the early to mid 60’s, men are diagnosed much more frequently than women, African American’s are diagnosed twice as often as white Americans, a study by the American Cancer Society shows that obesity increases the risk of multiple myeloma, exposure to radiation accounts for a small number of cases diagnosed and petroleum workers have shown a slight increase in the diagnosis of multiple myeloma. Symptoms of multiple myeloma vary from person to person. Initially the symptoms may not be noticed. As the disease progresses, most patients will experience at least one of the four major symptoms. The symptoms are sometimes referred to by...
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...costs are very high and it is because of chronic conditions, such as, “diabetes”, “coronary artery disease”, “Heart Disease”, “Cancer”, “Stroke”, “HIV or Aids”, “congestive heart failure”, “depression and asthma”, and the growing population in the “increase of obesity” not to mention the “lifestyles” people are living (“Gathering and Using Data for value-based Health Care Initiatives,” 2012, pp. 33-34) “According to Claiborne and Vandendurgh (2001)”, The disease trends in the United States of America is affecting millions of Americans today because usually some people wait until they are very sick until they decide to get the treatment they need, and when they wait it becomes more cost effective and the costs are then higher than usual because they wait until and become sicker or their illness will cost more to treat them, such as “diabetes”, if a male or female thinks they might have diabetes instead of them going to his or her family doctor they decide the “Emergency Room” would be better, which is not better because it cost more money to see a patient in the “emergency room” or if they wait to go be seen by a doctor his or her medical condition can get worse and cost more money and therefore it would best to see a doctor as soon as you start having any type of symptoms. Over the past several years Health Care facilities has advanced, and the overall “quality of care” for people has changed dramatically, but when it comes to chronic...
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...Cardiac – Coronary Artery Disease/Acute Myocardial Infarction Topic: Cardiac – Coronary Artery Disease/Acute Myocardial Infarction 1 Cardiac – Coronary Artery Disease/Acute Myocardial Infarction Table of Contents Introduction...................................................................................................................3 Patient’s profile..............................................................................................................4 Pathophysiology...............................................................................................................................5 Clinical manifestations...................................................................................................................6 Short of breath and ‘light headed’...................................................................................................6 Nauseous and uncomfortable feeling...............................................................................................6 Crushing substernal chest pain .......................................................................................................6 Modifiable and Non-modifiable risk factors.................................................................7 Laboratory tests results and ECG findings................................................................................7 ECG (Electrocardiogram)....................................................................
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...Throughout Organ Systems General anatomy of kidneys, appendix, gallbladder, pancreas, spleen, male and female reproductive organs. Costochondritis vs Angina Pectoris vs Myocardial Infarctions. Rheumatoid arthritis Gout lab findings Week 3 Fluid Balance and Edema Electrolyte imbalances of sodium, potassium, calcium, and magnesium. Intra and Extra cellular concentrations of sodium and potassium as related to osmotic balance. Know the physical signs/symptoms of electrolyte imbalances including hyper and hypo natremia, kalemia, and calcemia. SIADH lab and imaging findings Diabetes insipidus lab and imaging findings Week 4 Topic 4 Acidosis and Alkalosis Know your acid-bases! Week 5 Topic 5 Cardiovascular Causes of Fatigue Cor-pulmonale, cardiomyopathies Week 6 Topic 6 Thyroid, Adrenal, Liver Fatigue Hashimoto’s thyroiditis vs. DeQuervain vs. nodular goiter vs. secondary hypothyroidism Cirrhosis, Addison disease lab tests and hormone responsible. Is it high or low? Week 7 Topic 7 Bleeding as Indicator of Disease Pathophysiology of Disseminated Intravascular Coagulation Pathophysiology of Hemophilia Ulcers Week 8 Topic 8 Fever and Chills Beta-hemolytic streptococcus and Rheumatic fever signs/symptoms and lab findings (and Infective Endocarditis). Acute lymphocytic leukemia, Acute myelogenous leukemia, Chronic myelogenous leukemia, Hodgkin lymphoma, Burkitt lymphoma, Multiple Myeloma signs, symptoms, and lab findings Glomerulonephritis, mononucleosis ...
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...J. A. Care Plan Tamara Parker South College Medical Dx: Depression Allergies: Demerol, Oxycodone Hx: 91 y/o female brought to Shannondale from Blount Memorial with multiple fractures which she sustained from falling out of her bed. Patient suffers from chronic back pain and has hx of osteoporosis, muscle weakness, glaucoma, hyperlipidemia, kyphoplasty with bone fusion, back fusion, stemi, OA, and depression. |Neuro: |GU: | |Alert and oriented x3. Little confusion |No bowel movement since 3/2/16. Urine x1. | | | | |EENT: |MS: | |PERRLA, normocephalic, presbyopia. |Generalized weakness, uses wheelchair, needs little assistance with ADL’s. | | ...
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...renal impairment, NIDDM or IDDM.Promotes incorporation of water into stool, resulting in softer fecal mass, may also promote electrolyte and water secretion into the colon. It increases the amount of water and fat absorbed by the feces, softening the stool and making it easier to pass.Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. | Contraindicated with allergy to acetaminophen. Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation. Adverse effects CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr GI: Hepatic toxicity and failure, jaundice GU: Acute kidney failure, renal tubular necrosis Contraindications Hypersensitivity; severe chronic heart failure, bronchial asthma or related bronchospastic conditions; severe hepatic impairment. Adverse effects Bradycardia, AV...
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...Current diagnosis COPD/Emphysema. Patient XX was diagnosed with COPD in 2009. COPD is a progressive disease with presence of airflow obstruction, which may be cause by chronic bronchitis or emphysema. Emphysema is a pathological condition caused by the destruction of alveolar walls and a consequent permanent enlargement of the alveolar sacs. According to the National Institute of Health (NIH), a diagnosis of COPD is made based on the patient’s signs and symptoms, medical and family history, and results of diagnostic tests. Common signs and symptoms of COPD include cough, dyspnea, wheezing, and chest tightness. Most patients are older than 50 years. They present with major complaints of severe dyspnea and require the use of accessory muscles...
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