Study Material
Myocardial infarction (MI), commonly known as a heart attack. MI is a blockage of blood flow to the heart muscle. Myocardial infarction (MI) refers to tissue death (infarction) of the heart muscle (myocardium). It is a type of acute coronary syndrome, which describes a sudden or short-term change in symptoms related to blood flow to the heart. Myocardial infarction is a common presentation of coronary artery disease. The World Health Organization estimated in 2004, that 12.2% of worldwide deaths were from ischemic heart disease.
Study Material
Myocardial infarction (MI), commonly known as a heart attack. MI is a blockage of blood flow to the heart muscle. Myocardial infarction (MI) refers to tissue death (infarction) of the heart muscle (myocardium). It is a type of acute coronary syndrome, which describes a sudden or short-term change in symptoms related to blood flow to the heart. Myocardial infarction is a common presentation of coronary artery disease. The World Health Organization estimated in 2004, that 12.2% of worldwide deaths were from ischemic heart disease.
Definition, classification, epidemiology, etiology, diagnosis, prognosis of DCM, HOCM, LVNC
Also review of acute myocarditis in children
R/v of heart failure management
Cardiology 1.3. Syncope - by Dr. Farjad IkramFarjad Ikram
Introduction to one of the more challenging symptoms to investigate. Syncope is transient loss of consciousness with loss of postural tone due to diffuse hypoperfusion of cerebral cortex, followed by rapid, complete and spontaneous recovery.
Template design credits - http://www.slidescarnival.com
Definition, classification, epidemiology, etiology, diagnosis, prognosis of DCM, HOCM, LVNC
Also review of acute myocarditis in children
R/v of heart failure management
Cardiology 1.3. Syncope - by Dr. Farjad IkramFarjad Ikram
Introduction to one of the more challenging symptoms to investigate. Syncope is transient loss of consciousness with loss of postural tone due to diffuse hypoperfusion of cerebral cortex, followed by rapid, complete and spontaneous recovery.
Template design credits - http://www.slidescarnival.com
Periodontal Treatment of Medically Compromised Patients [Autosaved].pptxANIL KUMAR
The world's population is estimated to be over 7.7 billion. [1] Within this mass of humanity is a
substantial number of people who are elderly; the graying of the world's population is predicted to
produce millions of individuals with systemic medical conditions that can affect oral health and
dental treatment. The dental management of these medically compromised patients can be
problematic in terms of oral complications, dental therapy, and emergency care
Angina pectoris is a clinical syndrome usually characterized by episodes of pain or pressure in the anterior chest . The cause is usually insufficient coronary blood flow which results in a decreased oxygen supply to meet an increased myocardial demand for oxygen in response to physical exertion or emotional stress.
Angina also known as angina pectoris is a medical condition characterized by chest pain usually left sided due to inadequate blood supply (ischemia) to the heart muscles due to obstruction (like presence of blood clot), narrowing or contraction (vasospasm) of the supplying coronary arteries.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Coronary Artery disease Is characterized by the accumulation of plaque within coronary arteries, which progressively enlarge, thicken and calcify. This causes critical narrowing of the coronary artery lumen (75% occlusion), resulting in a decrease in coronary blood flow and an inadequate supply of oxygen to the heart muscle.
3.
4. Ischemia may be silent (asymptomatic but evidenced by ST depression of 1 mm or more on electrocardiogram (ECG) or may be manifested by angina pectoris (chest pain).
5. Risk factor for Coronary Artery Disease include dyslipidemia, smoking, hypertension, male gender (women are protected until menopause), aging, non-white race, family history, obesity, sedimentary lifestyle, diabetes mellitus, metabolic syndrome, elevated homocysteine, and stress.
6. Acute coronary syndrome is a complication of CAD due to lack of oxygen to the myocardium. Mnaifestations include unstable angina, non ST-segment elevation infarction, and ST-segment elevation infarction.
7. Other causes of angina include coronary artery spasm, aortic stenosis, cardiomyopathy, severe anemia, and thyrotoxicosis.
8. Assessment: Chest pain is provoked by exertion or stress and is relieved by nitroglycerin and rest. Character. Substernal chest pain, pressure, heaviness, or discomfort. Other sensations include a squeezing, aching, burning, choking, strangling, or cramping pain.
9.
10. Severity. Pain maybe mild or severe and typically present with a gradual buildup of discomfort and subsequent gradual fading away. Location. Behind middle or upper third of sternum; the patient will generally will make a fist over the site of pain (positive Levine sign; indicates diffuse deep visceral pain), rather than point to it with fingers.
11. Radiation. Usually radiates to neck, jaw, shoulders, arms, hands, and posterior intrascapular area. Pain occurs more commonly on the left side than the right; may produce numbness or weakness in arms, wrist, or hands. Duration. Usually last 2 to 10 minutes after stopping activity; nitroglycerin relieves pain within 1 minute.
12. Precipitating factors. Physical activity, exposure to hot or cold weather, eating a heavy meal, and sexual intercourse increase the workload of the heart and, therefore, increase oxygen demand. Associated manifestation. Diaphoresis, nausea, indigestion, dyspnea, tachycardia, and increase in blood pressure.
13. Diagnostic Evaluation: Resting ECG may show left ventricular hypertrophy, ST-T changes, arrhythmias, and possible Q waves. Exercise stress testing with or without perfusion studies shows ischemia. Fasting blood levels of cholesterol, low density lipoprotein, high density lipoprotein, lipoprotein A, homocysteine, and triglycerides may be abnormal. Coagulation studies, hemoglobin level, fasting blood sugar as baseline studies.
14. Cardiac catheterization shows blocked vessels. Position emission tomography may show small perfusion defects. Radionuclide ventriculography shows wall motion abnormalities and ejection fraction.
15. Fasting blood levels of cholesterol, low density lipoprotein, high density lipoprotein, lipoprotein A, homocysteine, and triglycerides may be abnormal. Coagulation studies, hemoglobin level, fasting blood sugar as baseline studies.
16. Pharmacologic Interventions: Antianginal medications (nitrates, beta-adrenergic blockers, calcium channel blockers, and angiotensin converting enzyme inhibitors) to promote a favorable balance of oxygen supply and demand. Antilipid medications to decrease blood cholesterol and tricglyceride levels in patients with elevated levels. Antiplatelet agents to inhibit thrombus formation. Folic acid and B complex vitamins to reduce homocysteine levels.
17. Surgical Interventions: Percutaneoustransluminal coronary angioplasty or intracoronary atherectomy, or placement of intracoronarystent. Coronary artery bypass grafting. Transmyocardial revascularization.
18. Nursing Interventions: Monitor blood pressure, apical heart rate, and respirations every 5 minutes during an anginal attack. Maintain continuous ECG monitoring or obtain a 12-lead ECG, as directed, monitor for arrhythmias and ST elevation. Place patient in comfortable position and administer oxygen, if prescribed, to enhance myocardial oxygen supply.
19. Identify specific activities patient may engage in that are below the level at which anginal pain occurs. Reinforce the importance of notifying nursing staff whenever angina pain is experienced. Encourage supine position for dizziness caused by antianginals.
20. Be alert to adverse reaction related to abrupt discontinuation of beta-adrenergic blocker and calcium channel blocker therapy. These drug must be tapered to prevent a “rebound phenomenon”; tachycardia, increase in chest pain, and hypertension.
21. Explain to the patient the importance of anxiety reduction to assist to control angina. Teach the patient relaxation techniques. Review specific factors that affect CAD development and progression; highlight those risk factors that can be modified and controlled to reduce the risk.
22. ANGINA a temporary chest pain that results from inadequate oxygen flow to the myocardium. It’s usually described as burning, squeezing, or a tight feeling in the substernal or precordial chest. This pain may radiate to the left arm, neck, jaw, or shoulder blade. Typically, the patient clenches his fist over his chest or rubs his left arm when describing the pain, which may also be accompanied by nausea, vomiting, fainting, sweating, and cool extremities.
23. Angina commonly occurs after physical exertion, but may also follow emotional excitement, exposure to cold, or a large meal. It may also develop during sleep, and symptoms may awaken the patient.
24. When assessing for anginal pain, older adults commonly have an increased tolerance for pain, and may be less likely to complain. Instead, they may compensate by slowing their activity levels. Older adults may not experience chest pain at all, but may report dyspnea, faintness, or extreme fatigue.
25. The person’s health history may suggest a pattern to the type and onset of pain. If the pain is predictable and relieved by rest or nitrates, it’s called stable angina. If it increases in frequency and duration and is more easily induced, it’s referred to as unstable angina or unpredictable angina. Unstable angina may occur at rest and generally indicates extensive or worsening disease that may progress to an MI. Variant or Prinzmetal’s angina is caused by coronary artery spasm, and commonly occurs at rest without initial increased oxygen demand.
26. Patient Care Management Goal: to relieve acute pain and reduce the cardiac work load Administer oxygen to relieve ischemia at a flow rate based on institutional policy and the patient’s condition. Assess and document continuous ECG rhythm, vital signs, mental status, heart and lung sounds. Assess and document pain characteristics: location, duration, intensity (have patient grade pain on a scale from 1 to 10), precipitating factors, relief measures and any symptoms that indicate changes in these parameters.
27. Assess vital signs with complaints of chest pain, and compare to baseline. Begin IV nitroglycerin titrated until acute pain is relieved; check blood pressure every 15 minutes or according to institutional policy; maintain systolic blood pressure greater than 90 mm Hg or according to institutional protocol; document the patient’s response to therapy. Administer IV morphine in small doses to relieve pain and decrease preload.
28. Give sublingual, oral, or topical nitroglycerin prophylactically for chronic pain. Consider calcium channel blockers with Prinzmetal’s angina to block the influx of calcium into the cell; calcium channel blockers produce vasodilation of coronary and peripheral arteries. Use beta-adrenergic blockers to decrease myocardial oxygen demand by decreasing contractility, heart rate, and blood pressure. Notify the doctor and obtain a 12-lead ECG at the onset of recurring chest pain.
29. Maintain activity restrictions based on the patient’s activity tolerance to reduce myocardial oxygen demands. Begin the patient on a low-cholesterol, low-sodium diet to alleviate the modifiable risk factors. Consider percutaneoustransluminal coronary angioplasty (PTCA) to improve blood flow through the stenotic coronary arteries.
30. Remember that a coronary artery bypass graft (CABG) may be indicated when medical treatment has been unsuccessful, based on the patient’s symptoms and the cardiac catheterization report. Provide patient education, and ensure that the patient can recognize signs and symptoms necessitating medical attention (unrelieved chest pain after taking three nitroglycerin tablets sublingually 5 minutes apart).
31. Work with the patient and family to identify the patient’s risk factors and necessary life style modifications. Refer the family to appropriate sources for cardiopulmonary resuscitation (CPR) training. Ensure that the family can activate the emergency medical system if any problems occur at home.
32. ACUTE MYOCARDIAL INFARCTION Refers to a dynamic process by which one or more regions of the heart muscle experience a severe and prolonged decrease in oxygen supply because of insufficient coronary blood flow. The affected muscle tissue subsequently becomes necrotic.
33.
34. Onset of Myocardial Infarction may be sudden or gradual, and the process takes 3 to 6 hours to run its course.
35. It is the most serious manifestation of acute coronary syndrome, a complication of coronary artery disease (CAD). Approximately 90% of Myocardial Infarction are precipitated by acute coronary thrombosis (partial or total) secondary to severe CAD (greater than 70% narrowing of the artery).
36. Other causative factors include coronary artery spasm, coronary artery embolism, infectious diseases causing arterial inflammation, hypoxia, anemia, and severe exertion or stress on the heart in the presence of significant coronary artery disease.
37. Assessment: Chest pain Character: variable, but often diffuse, steady substernal chest pain. Other sensations include a crushing and squeezing feeling in the chest. Other sensations include a crushing and squeezing feeling in the chest. Severity: pain may be severe; not relieved by rest or sublingual vasodilator therapy, requires opioids.
38. Location: variable, but often pain resides behind upper or middle third of sternum. Radiation: pain may radiate to the arms (commonly the left), and to the shoulders, neck, back, or jaw. Duration: pain continues for more than 15 minutes.
39. Associated manifestations include anxiety, diaphoresis, cool clammy skin, facial pallor,hypertension or hypotension, bradycardia or tachycardia, premature ventricular or atrial beats, palpitations, dyspnea, disorientation, confusion, restlessness, fainting, marked weakness, nausea, vomiting, and hiccups.
40. Atypical symptoms of MI include epigastric or abdominal distress, dull aching or tingling sensations, shortness of breath, and extreme fatigue (more frequent in women).
41. Risk factors for MI include male gender, age over 45 for men, age over 55 for men, smoking; high blood cholesterol levels, hypertension, family history of premature CAD, diabetes and obesity.
42. Diagnostic Evaluation: Serial 12-lead electrocardiograms (ECGs) detect changes that usually occur within 2 to 12 hours, but may take 72 to 96 hours ST-segment depression and T-wave inversion indicate a pattern of ischemia; ST elevation indicates an injury pattern. Q waves indicate tissue necrosis and are permanent Nonspecific enzymes including aspartatetransaminase, lactate dehydrogenase, and myoglobulin may be elevated More specific creatininephosphokinaseisoenzyme CK-MB will be elevated.
43. Triponin T and I are myocardial proteins that increase in the serum about 3 to 4 hours after an MI, peak in 4 to 24 hours, and are detectable for upto 2 weeks; the test is easy to run, can help diagnose an MI up to 2 weeks earlier, and only unstable angina causes a false positive. White blood cell count and sedimentation rate may be elevated. Radionuclide imaging, positron emission tomography, and echocardiography may be done to evaluate heart muscle.
44. Pharmacologic Intervention: Pain control drugs to reduce catecholamine-induced oxygen demand to injured heart muscle. Opiate analgesics: Morphine Vasodilators: Nitroglycerin Anxiolytics: Benzodiazepines Thrombolytic therapy by I.V. or intracoronary route, to dissolve thrombus formation and reduce the size of the infarction. Anticoagulants or other anti-platelet medications such as adjunct to thrombolytic therapy.
45. Reperfusion arrhythmias may follow successful therapy. Beta-adrenergic blockers, to improve oxygen supply and demand, decrease sympathetic stimulation to the heart, promote blood flow in the small vessels of the heart, and provide antiarrhythmic effects. Calcium channel blockers, to improve oxygen supply and demand.
46. Nursing Interventions: Monitor continuous ECG to watch for life threatening arrhythmias (common within 24 hours after infarctions) and evolution of the MI (changes in ST segments and T waves). Be alert for any type of premature ventricular beats- these may herald ventricular fibrillation or ventricular tachycardia. Monitor baseline vital signs before and 10 to 15 minutes after administering drugs. Also monitor blood pressure continuously when giving nitroglycerin I.V.
47. Handle the patient carefully while providing care, starting I.V. infusion, obtaining baseline vital signs, and attaching electrodes for continuous ECG monitoring. Reassure the patient that pain relief is a priority, and administer analgesics promptly. Place the patient in supine position during administration to minimize hypotension.
48. Emphasize the importance of reporting any chest pain, discomfort, or epigastric distress without delay. Explain equipment, procedures, and need for frequent assessment to the patient and significant others to reduce anxiety associated with facility environment.
49. Promote rest with early gradual increase in mobilization to prevent deconditioning, which occurs during bed rest. Tell the patient that sexual relations may be resumed on advise of health care provider, usually after exercise tolerance is assessed.
50. Be alert to signs and symptoms of sleep deprivation such as irritability, disorientation, hallucinations, diminished pain tolerance, and aggressiveness. Take measures to prevent bleeding if patient is thrombolitic therapy
51. Interventional cardiology is a branch of cardiology that deals specifically with the catheter based treatment of structural heart diseases.
54. Valvuloplasty It is the dilation of narrowed cardiac valves (usually mitral, aortic, or pulmonary).
55. Congenital heart defect correction Percutaneous approaches can be employed to correct atrialseptal and ventricular septal defects, closure of a patent ductusarteriosus, and angioplasty of the great vessels. Percutaneous valve replacement: An alternative to open heart surgery, percutaneous valve replacement is the replacement of a heart valve using percutaneous methods.
57. 3]Cardiac ablation A technique performed by clinical electrophysiologists, cardiac ablation is used in the treatment of arrhythmias.
58.
59. Dysrhytmias Disorders of the formation and/or conduction of electrical impulses in the heart Cause disturbances of heart rate and/or heart rhythm May be evidenced by changes in hemodynamics Diagnosed by analyzing electrocardiogram
69. Conduction Abnormalities First-Degree Atrioventricular Block Second-Degree Atrioventricular Block, Type I Second-Degree Atrioventricular Block, Type II Third-Degree Atrioventricular Block
71. Pacemaker Therapy Provides electrical stimuli to heart muscle Used for slower-than-normal impulse formation, to control some tachycardias, or for advanced heart failure May be permanent or temporary
72. Pacemaker Therapy (cont’d) NASPE-BPEG code First letter identifies chambers being paced Second letter describes the chambers being sensed Third letter describes type of response by pacemaker to what is sensed
73.
74. Cardioversion and Defibrillation Delivery of electrical current to depolarize a critical mass of myocardial cells When cells repolarize the SA node, is usually able to recapture its role as pacemaker of heart Cardioversion involves use of “timed” electrical current to terminate a tachydysrhythmia
75. Cardioversion and Defibrillation (cont’d) Defibrillation is used in emergency situations as treatment for ventricular fibrillation and pulseless VT
76. Heart Failure Chronic heart failure managed based upon type, severity, and cause Diastolic heart failure Systolic heart failure Ejection performed to assist in diagnosis
77.
78.
79. Left-Sided Heart Failure Pulmonary congestion occurs when left ventricle cannot pump well Dyspnea upon exertion, orthopnea, and paroxysmal nocturnal dyspnea Oliguria
80. Right-Sided Heart Failure Congestion of viscera and peripheral tissues when right ventricle fails Jugular vein distention Dependent edema Hepatomegaly Ascites Weakness, anorexia, and nausea Weight gain
81.
82. Medical Management Eliminate or reduce contributing factors Reduce workload of heart by reducing afterload and preload Pharmacologic Therapy ACE inhibitors and ARBs Hydralazine and isosorbidedinitrate Beta-blockers Diuretics Digitalis Calcium channel blockers Other: anticoagulants and antianginal medications Low Sodium Diet
83. Nursing Management I&O Weigh daily Auscultate lung sounds Determine degree of JVD Assess dependent edema Monitor VS
87. Myocardial Rupture and Cardiac Arrest Myocardial rupture is rare. Can occur as result of MI, infectious process, cardiac trauma, pericardial disease, or other myocardial dysfunction Result is immediate death Cardiac arrest occurs when heart ceases to produce effective pulse and blood circulation Pulseless electrical activity Emergency Management is CPR
88.
89. The power of love to change bodies is legendary, built into folklore, common sense, and everyday experience. Love moves the flesh, it pushes matter around.... Throughout history, "tender loving care" has uniformly been recognized as a valuable element in healing. ~Larry Dossey