While being observed in the coronary care unit, the patient continues to have ch
ID: 3481142 • Letter: W
Question
While being observed in the coronary care unit, the patient continues to have chest pain, as well as these changes in his vital statistics: 12:00 a.m. HR 107 bpm BP 112/70 1:30 a.m. HR 107 bpm BP 92/50 4:00 a.m. HR 98 bpm BP 88/44 8:00 a.m. HR 106 Using the scenario above, fill in the blank with the appropriate answer. BP 84/50 6 Based on your knowledge, what does the increase in heart rate and decrease in blood pressure indicate? Based on your knowledge, this patient continues to have chest pain even though he has received appropriate medication. This indicates his angina is stable or unstable? 7 8·Based the EKG, which coronary artery do you think is on the problem? (Look at the chest leads, which leads are involved and tell me which coronary vessel feeds that part of the heart) The cardiac catherization identified that the vessel was 100% blocked by clots Based on your knowledge of coronary interventions, which intervention do you think is most appropriate at this time? (Coronary Artery Bypass Graft Surgery or Angioplasty) The cardiac catherization identified that the Ejection Fraction is 40-45% and hypokinesis of the anterolateral wall, which chamber of the heart is damaged? 10Explanation / Answer
6. Increase in heart and decrease in blood pressure can be seen in conditions like Tachycardia, Atrial fibrillation(a type of Supraventricular tachycardia), Vasovagal syncope or some times it may occur as a result of adverse effect due to administration of drugs like Calcium channel blockers(Nifedipine, amlodipine, diltiazem) , diuretics(Frusemide, Bumetanide, ethacrynic acid)
The underlying causes may be disruption of balance between blood pressure and heart rate(dysfunction blood pressure regulating mechanisms), irregular generated impulses in right atrium, coronary artery disease, obstructive sleep apnea, hyperthyroidism, mitral stenosis, alcoholism, hypovolemia, nicotine, Wolff-Parkinson-White syndrome etc
7. Continuance of pain even after medication denotes that the angina is Unstable angina. Unstable angina can occur with or without physical exertion and independent of rest. It is severe and dangerous requiring immediate medical attention.
Angina pectoris is a referred pain radiating to the left shoulder and entire left arm due to the poor blood flow to the myocardium occuring as a result of atherosclerosis(narrowing of coronary arteries due to plaque formation). Angina may be stable, unstable and prinzmetal(variant angina).
8. EKG(Electrocardiogram) is not included in the question only the heart rate and blood pressure values are given. Please upload the other side of the question paper also to get the accurate answer. But here is the help to know:
Right coronary artery occlusion can be determined from leads II, III and aVF,
Left coronary artery occlusion can be understood from leads Lateral I, aVL
ST elevation denotes infarction, ST depression and T wave inversion ; Q wave indicates a previous infarction
EKG graph in the question could have been more helpful to answer this
9. Angioplasty is recommended in this case, as it is unstable angina. There is no multiple coronary artery occlusion(since ECG information is not given, assuming from Que 8 "which coronary artery is affected" has only one artery involved in the answer) and recovery is quick when compared to Coronary Artery Bypass Graft(CABG) surgery, no Diabetic implications are given in the question(which requires CABG), hence Angioplasty is the most appropriate intervention.
10. Left ventricle could be damaged. Ejection fraction of 40-45% is showing that person is in borderline and developing cardiomyopathy
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