c


   

 
 
 
 



 



1.) Patient X poses many risk factors associated with atherosclerosis. The first risk factor is his

age, because simply getting older increases your chances for the disease. Other factors

include obesity, heavy cigarette smoking, elevated blood pressure, and finally his chances

for having high cholesterol is great because he prefers a diet filled with fried foods.

½ 
 


 

   

½.) Atherosclerosis is a type of arteriosclerosis which is a hardening of the arteries.

Atherosclerosis is a build-up of plaques or fats in the artery walls that restrict blood flow. Clots from

the plaques can form and burst in these arteries. The restriction of blood flow or the clots can cause

the patient to have a heart attack.

 


 


    ! 


   "

.) Many people write off chest pain as indigestion when in fact it closely mirrors what is really

Angina. Angina is a chest pain resulting from a reduced blood flow to the heart. When your heart is

deprived of oxygen-rich blood due to a coronary artery disease like angina, you will experience a

tightness, squeezing, pain, and pressure in your chest. In angina there is no permanent damage

done to the heart muscle, but when the interruption of blood flow lasts longer heart muscle dies

and this is called a heart attack.

£ ! #$    
 



 £.) One of the causes of weak pulse is a cardiac arrhythmia that weakens the pulse and also

presents with cool and clammy skin just like patient X had. Patients who have arteriosclerosis will

have a pulse that is weakened in the limbs. Tachycardia is when the heart is beating too fast and

occurs during an arrhythmia. Coupled with the weak pulse is a classic sign for a myocardial

infarction.

Ñ !   



Ñ.) As in the ER I work in, when a patient of this age range has chest pain, cool and clammy skin,

anxious behavior, fatigue, a high, weak or irregular pulse coupled with an elevated blood pressure

will definitely get you admitted to the ER. Top that with a family history of heart attacks and death

and you could spend the night in the ER.

ÿ u 
% "
 &

ÿ.) Serum enzymes only show up in the blood when the cells they are in are damaged or

destroyed. Depending on the elevated level of the enzymes will determine the amount of tissue

damage to the area ,thus determining if the patient has suffered a heart attack. Electrolyte levels

include sodium, potassium, chloride, and bicarbonate. A low sodium blood concentration is found in

patients with congestive heart failure. Potassium regulates the heart beat and heart muscle

functions so a profound decrease of potassium called hypokalemia can increase the chance of an

arrhythmia and be fatal. Chloride controls the normal balances of fluids in the body and extreme

levels can be fatal. Bicarbonate ions control the levels of acidity in the blood and abnormal levels

can interfere with respiratory functions.

- u 

 c'
"&

 -.) An ECG monitors the electrical activity of the SA and AV node which causes the muscle in the

atria and ventricles to contract. The standard ECG preformed is a 1½ lead view of the heart. The 

waves viewed in an ECG are the P, QRS, and T waves. The P wave is your atrial contraction, QRS

wave is ventricular contraction, and T wave is what happens during repolarization or when

ventricles are recharging for the next contraction. The standard 1½ view would be used in patient X

on his initial visit but since he had a large infarction on the anterior left ventricle, the next ECG he

has should be a 1½ lead right view in which all of the leads are placed on the opposite side of the

chest giving the physician a better view of the left side of the damaged heart.

‰ #$


()c
 c'  
 



*

‰.) PVC or premature ventricular contraction are premature heartbeats from the ventricles of

the heart and come before the actual heartbeat. After a PVC, the electrical system of the heart

resets and this causes a brief pause in the heartbeat. The main causes are lack of oxygen to the

heart, heart attack, high blood pressure, electrolyte imbalances, and CHF. Many medications,

excessive caffeine, drug use, and alcohol abuse can also cause PVCs. If PVCs continue to increase in

frequency the patient could end up with a decreased cardiac output and even R on T phenomenon

which is when the R waves interrupt the T waves resulting in a miscommunication of the AV node

thinking the SA node has already fired, which results in neither the SA or AV node firing and this

throws the patient into cardiac arrest.

· ! #$
 
"




·.) Mr. X has had a Myocardial Infarction, suspected angina, and lower leg pain which all put him

as a higher risk for DVT that can result in a pulmonary embolism.

+
#$
   

 

10.) A heart attack causes scar tissue from the heart being deprived from oxygen. As soon as

blood flow is restored to the heart white blood corpuscles go the site of the damage and remove the

dead cell and scar tissue if formed. Since scar tissue cannot contract like normal tissue this adds

pressure to the heart͛s pumping action. Depending on the size of the blockage and the amount of

scar tissue will determine if blood flow will be blocked. The scar tissue can also interfere with the

heart͛s electrical rhythm or signals, and cause arrhythmia.




   "

 


   

"


11.) Hyperlipidemia is defined as an excessive amount of lipids or fatty substances in the blood.

Low density proteins (LDL) are your lipoproteins in the blood which are the fat protein complexes.

An excess amount of LDL͛s puts a person at greater risk of heart attacks. The risk of another

myocardial infarction for patient X is very high unless he changes his diet, lifestyle, and takes

medication to reduce his LDL levels.

½

" 

  


1½.) Patient X needs to quit smoking, cut out fried foods, excess amounts of red meat, lose

weight, exercise, and consult his physician for medication to regulate his cholesterol and triglyceride

levels as well as regulate his blood pressure.

#$
 

"   

 


"


1.) Congestive heart failure impairs the pumping ability of the heart and results in fluid build-up

in the body. Symptoms of congestive heart failure are fatigue, edema of the abdomen, legs, and/or
ankles, shortness of breath, difficulty breathing during sleep, and increased urination due to excess

fluids in the body.

£
 


    !

 &

1£.) Due to atherosclerosis, the thickening of the artery walls caused reduced blood flow and

pressures that results in reduced blood flow, slowing circulation. This can be connected to the

fatigue and leg pain Mr. X experienced while playing golf.

Ñ

 
   #$  

1Ñ.) If Mr. X is diagnosed with CHF he will most likely experience some edema in his lower limbs

so he should wear compression stockings to reduce swelling and at the end of the day if the swelling

persists, elevation of his feet will take pressure off of his heels and feet. Changing his lifestyle and

losing weight should include some non strenuous type of exercise such as walking. If Mr. X chooses

to take up walking or just want to use precautions for foot care I recommend he makes an

appointment with a Pedorthist, who specializes in fitting people with footwear designed to improve

circulation.
a
 

American Academy of Family Physicians. (½00‰, April). „

 



  

„

. Retrieved 10 ½Ñ, ½00·, from Family Doctor.ort:
http://familydoctor.org/online/famdocen/home/common/heartdisease/recovery/00½.html

American Heart Association. (½00‰, 11 ½£). 


 





. Retrieved 10 ½Ñ,
½00·, from American Heart.org: http://www.americanheart.org/presenter.jhtml?identifier=½Ñ1

Dennis Lee, M. (½00Ñ, 10 ½1).  
  




. Retrieved 10 ½Ñ, ½00·, from
MedicineNet.com: http://www.medicinenet.com/premature_ventricular_contractions/article.htm

Mayo Clinic. (½00·, June ½Ñ). 


. Retrieved October ½Ñ, ½00·, from Mayo Clinic.com:
http://mayoclinic.com/health/angina/DS00··£

Mayo Clinic. (½00‰, June ½‰).  

 

  
. Retrieved 10 ½Ñ, ½00·, from
MayoClinic.com: http://mayoclinic.com/health/arteriosclerosis-atherosclerosis/DS00ѽÑ

WebMD, LLC. (½00·).  


 
. Retrieved 10 ½Ñ, ½00·, from Electrocardiogram(ECG):
http://www.emedicinehealth.com/electrocardiogram_ecg/article_em.htm

Worth, R. (½00·, 10 ½ÿ). Nurse Practitoner. (H. LeBatard, Interviewer)