33. Diabetes High Blood Pressure Physical Inactivity Over 40 Vascular Disease High Cholesterol Previous MI Obesity Smoking Family History Unhealthy Dietary Habits Risk Factors
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37. lleregies A M P L E edications revious medical, surgical and family history ast meal vents Assessment
38. osition: Where is the Pain? P Q R S T A A A uality: What does the pain feel like? [sharp, dull, burning] adiation: Does the pain move anywhere? everity: Rate the pain on a scale between 0 and 10 iming: When did the pain start? Is it continuous? lleviating factors: What makes it better? ggravating factors: What makes it worse? ssociated symptoms: e.g., nausea / pins and needles Assessment
RCA is dominant in 84% of people Dominant artery usually does not perfuse largest % of myocardium Arise from aorta left branches into two large vessels right branches into single vessel from aortic sinus Can dilate meeting increased demand
Contributes approximately 30% of CO alterations in atrial contraction effect CO
Pulse – pulse deficit listen to apex and feel radial – if there is a difference this indicates a pulse deficit
S2 split – A2 = aortic valve closure, P2 = pulmonic valve closure. On inspiration, venous return to the heart is impeded and pulmonic valve closure is delayed resulting in a split sound. Can be normal in some people. Get patient to hold breath to hear this better S3 – left ventricular failure: and is caused by blood from the left atrium slamming into an already overfilled ventricle during early diastolic filling S4 - left ventricular hypertrophy: blood trying to enter a stiff, non-compliant left ventricle during atrial contraction
B 2 via HM or NRB C FBC: Hb anaemia, WCC infection UEC: electrolyte imbalance CP: coagulation ?PE CK / Troponin: muscle / cardiac enzymes ABG: ventilation / perfusion status F Observations 5mins apart G Analgesia / medications
B 2 via HM or NRB C FBC: Hb anaemia, WCC infection UEC: electrolyte imbalance CP: coagulation ?PE CK / Troponin: muscle / cardiac enzymes ABG: ventilation / perfusion status F Observations 5mins apart G Analgesia / medications
Anginine Vasodilator, decreases preload and afterload therefore decreasing the workload of the heart, dilates coronary arteries Aspirin Platelet aggregation inhibitor a study of 17,000 people showed a reduced re-infarction rate of 50% Morphine Analgesia, decreases anxiety, Clopidogrel Platelet aggregation inhibitor GTN Infusion Blood pressure control, reduces pain