...at a rate sufficient for metabolic requirements under normal filling pressure. It is characterised clinically by breathlessness, effort intolerance, fluid retention, and poor survival. Fluid retention and the congestion related to this can often be relieved with diuretic therapy. However, diuretic therapy should generally not be used alone and, if required, should be combined with the pharmacological therapies outlined in this review. Heart failure can be caused by systolic or diastolic dysfunction, and is associated with neurohormonal changes. [1] Left ventricular systolic dysfunction (LVSD) is defined as a left ventricular ejection fraction (LVEF) below 0.40. It may be symptomatic or asymptomatic. Defining and diagnosing diastolic heart failure can be difficult. Recently proposed criteria include: (1) clinical evidence of heart failure; (2) normal or mildly abnormal left ventricular systolic function; (3) evidence of abnormal left ventricular relaxation, filling, diastolic distensibility, or diastolic stiffness; and (4) evidence of elevated N-terminal-probrain natriuretic peptide. [2] However, assessment of some of these criteria is not standardised Top of Form Search the BMJ[pic][pic] Bottom of Form • BMJ • BMJ Journals • BMJ Careers • BMJ Learning • Evidence Centre • BMJ Group [pic] [pic] [pic] [pic] [pic] [pic] Home | Log in | Athens Log in | Shibboleth Log in | Help | Contact us [pic] Sections Full review list Top of Form [pic][pic] ...
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... how they work, and how they are transmitted. This helps us to better treat the disease. The process of epidemiology is lengthy but must be followed accurately to ensure correct diagnosis and treatment. Epidemiology is used when a new disease is found and when a disease reappears in high numbers. A common disease in the elderly is congestive heart failure (CHF). The epidemiology process can be used to better understand the disease, what causes it and how to treat it. According to the World Health Organization (WHO), “Epidemiology is the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems. Various methods can be used to carry out epidemiological investigations, such as surveillance and descriptive studies that can be used to study distribution and analytical studies are used to study determinants (WHO, 2011). Epidemiology tries to determine what causes disease and what people can do to prevent disease. Epidemiology was first used when scientists tried to discover causes of diseases, such as smallpox and polio (Cornell University, 1993). Epidemiology is no longer limited to transmissible diseases. Epidemiology usually cannot prove a cause of a disease; it can only show certain risk factors that correlate with a higher rate of a specific disease. For example, epidemiology could not prove that smoking causes lung cancer;...
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...Chronic Angina Case Study Advanced Pathophysiology 2/2/14 1) Basis for diagnosis: Six month history of intermittent chest discomfort, described as lower substernal tightness with numbness of the left upper arm, only during exertion. + exercise stress test with pain and 1.5mm of ST segment depression. Class of Angina: Class 1 Chronic angina is associated with a fixed or stable coronary obstruction that creates a disparity between coronary blood flow and the metabolic demands of the myocardium. It is usually precipitated by situations that increase the metabolic needs of the heart such as physical exertion, cold, and emotional stress and relieved within minutes by rest or nitroglycerin. These symptoms occur repeatedly over time, sometimes months to years. This fixed or stable plaque is commonly associated with chronic angina whereas the unstable plaque is associated with unstable angina and myocardial infarction. It is these unstable plaques that are most prone to abrupt plaque changes, followed by thrombosis, that lead to MI, stroke, and sudden cardiac death. These unstable plaques can be divided into three categories of Acute Coronary Syndrome: Unstable Angina, NSTEMI, and STEMI. The pathophysiology between UA and NSTEMI are similar and include these key features: development of an unstable plaque that ruptures or plaque erosion with superimposed non occlusive thrombosis, an obstruction by spasm, constriction, dysfunction, or adrenergic stimuli, severe narrowing...
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...Hypertension Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. Hypertension is the consistent elevation of systemic arterial blood pressure. It is also the most common primary diagnosis in the United States (Brashers, 2010). It is one of the most common worldwide diseases afflicting humans. Because of the associated morbidity and mortality and the cost to society, hypertension is an important public health challenge. Over the past several decades, extensive research, widespread patient education, and a concerted effort on the part of health care professionals have led to decreased mortality and morbidity rates from the multiple organ damage arising from years of untreated hypertension. I. Prevalence of disease (in US) and risk factors Hypertension is a major U.S. health problem affecting some 50 million individuals. Approximately 65% of Americans older than age 60 have hypertension. Of those diagnosed with hypertension, over 30% do not have their hypertension adequately treated and controlled. Ninety to ninety-five percent of hypertension is idiopathic and called primary hypertension. Five to ten percent of hypertension is the result of an identifiable etiologic cause and is called secondary hypertension. According to Center of Disease Control (CDC) the prevalence of hypertension, 45.3% had been treated...
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...emergency From Wikipedia, the free encyclopedia A hypertensive emergency is severe hypertension (high blood pressure) with acute impairment of an organ system (especially the central nervous system, cardiovascular system and/or the renal system) and the possibility of irreversible organ-damage. In case of a hypertensive emergency, the blood pressure should be substantially lowered over minutes to hours with an antihypertensive agent. Contents [hide] * 1 Treatment * 2 Incidence * 3 Definition * 3.1 Hypertensive emergency as a generic term * 4 Pathophysiology * 5 Mortality * 6 Clinical history * 7 References * 8 See also | ------------------------------------------------- [edit]Treatment Several classes of antihypertensive agents are recommended and the choice for the antihypertensive agent depends on the cause for the hypertensive crisis, the severity of elevated blood pressure and the patient's usual blood pressure before the hypertensive crisis. In most cases, the administration of an intravenous sodium nitroprusside injection which has an almost immediate antihypertensiveeffect is suitable but in many cases not readily available. In less urgent cases, oral agents like captopril, clonidine, labetalol, prazosin, which all have a delayed onset of action by several minutes compared to sodium nitroprusside, can also be used. It is also important that the blood pressure is lowered not too abruptly, but smoothly. The initial goal in hypertensive emergencies...
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...European Journal of Echocardiography (2011) 12, 421–430 doi:10.1093/ejechocard/jeq175 REVIEW Left atrial function: physiology, assessment, and clinical implications Gustavo G. Blume 1, Christopher J. Mcleod 1, Marion E. Barnes 2, James B. Seward 1, Patricia A. Pellikka 1, Paul M. Bastiansen 1, and Teresa S.M. Tsang 2* 1 Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA; and 2Division of Cardiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada Online publish-ahead-of-print 12 May 2011 The interest in the left atrium (LA) has resurged over the recent years. In the early 1980s, multiple studies were conducted to determine the normal values of LA size. Over the past decade, LA size as an imaging biomarker has been consistently shown to be a powerful predictor of outcomes, including major public health problems such as atrial fibrillation, heart failure, stroke, and death. More recently, functional assessment of the LA has been shown to be, at least as, if not more robust, a marker of cardiovascular outcomes. Current available data suggest that the combined evaluation of LA size and LA function will augment prognostication. The aim of this review is to provide a critical appraisal of current echocardiographic techniques for the assessment of LA function and the implications of such assessment for prediction and disease prevention. ------------------------------------------------------------------...
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...diomyopathy Topic presentation on Cardiomyopathy Topic presentation on Cardiomyopathy INDEX S.N | CONTENT | PG.NO | 1 | Introduction | 5 | 2 | Definition Cardiomyopathy | 5 | 3 | Classification | 6 | 4 | Risk Factors | 7 | 5 | Clinical Manifestations | 7 | 6 | Diagnostic Evaluation | 7-9 | 7 | Dilated CardiomyopathyDefinition,Charecteristics,Types , Causes,Diagnostic Evaluation,Pathophysiology,Clinical Manifestations,Medical Management | 10-17 | 8 | Hypertrophic CardiomyopathyIncidence,Causes,Charecteristics,Clinical Manifestations,Medical And Nursing Management | 18-21 | 9 | Restrictive Cardiomyopathy-Other Names,Causes,Pathophysiology,Clinical Manifestations,Diagnostic Evaluation,Medical Management | 23-26 | 10 | Surgical management | 27-32 | 11 | Prevention | | 12 | Nursing Management,Home Care Management | 32-40 | 13 | Complications | 40-42 | 14 | Conclusion | 42 | 15 | Research Abstract | 42-43 | 16 | References | 44 | GENERAL OBJECTIVE: On completion of the course the students aquires indepth knowledge regarding cardiomyopathy and able to apply this knowledge with a positive attitude. SPECIFIC OBJECTIVE: On completion of the course the students are able to ...
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...over 900000 people are living with heart failure, with 63000 new cases being diagnosed each year (BHF, 2015). It costs the NHS £625 million per year,as a result of the hight portion of emergency admission, readmission and long length of inpatient stay (NHS Improvement, 2010). DH (2000) confirmed that Heart failure accounts for about all cardiac admissions and readmission rate can be as high as 50% in the 3 months; also, it further estimated 50% readmission may be preventable. Unfortunately, Heart Failure can’t be cured, but early diagnosis and effective treatment can improve patients’ symptoms and quality of life, also it further reduce NHS cost (Presho, 2008). 2 Heart failure is a long-term condition disease; it may be the final and most severe manifestation of nearly every form of cardiac disease including myocardial infarction, vulvar diseases, hypertension, congenital diseases and the cardiomyopathies (NHS Choice, 2015). The ethnologist can be grouped as impaired ventricular contractility; increased afterload and impaired ventricular filling. There are three main type of heart failure: firstly, heart failure caused by left ventricular systolic dysfunction(LVSD), that is because left ventricular myocardial disease that is the most common pathologic abnormality to lead to heart failure can lead the part of the heart that pumps blood around the body becomes weak(Churchhouse and Ormerod, 2013). Myocardial dysfunction is most frequently the result of coronary artery disease and forms...
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...Heart Failure Western Governors University Pathopharmacological Foundations for Advanced Nursing Practice Heart Failure It is estimated that about five million people in the United States are living with heart failure with an overwhelming number of 550,000 newly diagnosed cases each year, costing the nation roughly $32 billion dollars per year (Centers for Disease Control and Prevention, 2016). Heart failure is a complex, pathophysiological condition in which the ventricles of the heart is weakened and unable to pump effectively to meet the body’s needs for nutrients or has lost adequate filling capacity. Clinical presentations of heart failure depends on which ventricles have failed to pump blood adequately; left ventricular failure, also known as congestive heart failure (CHF) is more common than right ventricular failure (McCance & Huether, 2014). The most common symptoms of heart failure are shortness of breath, fatigue, and peripheral edema. HF is not a disease, but rather a manifestation of a diseased heart. Large number of disorders can lead to heart failure, and with the aging population and many surviving primary cardiac events, it is no surprise that the most common reason for hospitalization in patients older than 65 years old is heart failure (McClintock, Mose, & Smith, 2014). Heart failure has become a major public health problem because it is the only cardiac condition that continues to increase in prevalence (McClintock, Mose, & Smith, 2014)...
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...Preventing Heart Failure Readmissions Henry D. Santos Purdue University Calumet I. Introduction High morbidity, mortality, and healthcare spending have been connected with heart failure management. As per Gheorghiade et al., every year, there are almost a million cases of hospitalization for heart failure, responsible for 6.5 million hospital days, and estimated expenditures of $37.2 billion here in the United States alone (2013). The incident of heart failure readmissions has increased over the last decades, distinctly related to the aging population and surpassed recovery after a myocardial infarction. Based on the Centers for Medicare and Medicaid Services (CMS) 2005 data, heart failure is the most frequent diagnosis among Medicare beneficiaries and the third highest reimbursement for hospitals (AHRQ, 2013). In 2009, CMS started the public reporting of readmission rates after being discharge for heart failure, and, the year after, the Patient Protection and Affordable Act inaugurated financial penalties for healthcare establishments with most rates of readmission within the 30 days after discharge. The elevated concern relating the want to decrease readmissions has been the biggest focused of national researchers and hospitals with the efforts of identifying and predicting which patients with heart failure are likely to be readmitted. Formulated designs and preventive strategies have been established, in order to avoid unnecessary readmissions. Heart failures risk...
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...inflammatory response syndrome (SIRS), sepsis, septic shock, and multiple organ dysfunction syndrome Systemic inflammatory response syndrome Two or more of the following clinical signs of systemic response to endothelial inflammation: • Temperature > 38°C or < 36°C x Heart rate > 90 beats/min • Tachypnoea (respiratory rate > 20 breaths/min or hyperventilation (Paco2 < 4.25 kPa)) • White blood cell count > 12 ⋅ 109/l or < 4 ⋅ 109/l or the presence of more than 10% immature neutrophils In the setting (or strong suspicion) of a known cause of endothelial inflammation such as: • Infection (bacteria, viruses, fungi, parasites, yeasts, or other organisms) • Pancreatitis x Ischaemia x Multiple trauma and tissue injury x Haemorrhagic shock x Immune mediated organ injury x Absence of any other known cause for such clinical abnormalities Sepsis Systemic response to infection manifested by two or more of the following: • Temperature > 38°C or < 36°C x Raised heart rate > 90/min • Tachypnoea (respiratory rate > 20 breaths/min or hyperventilation (Paco2 < 4.25 kPa)) • White blood cell count > 12 × 109/l or < 4 × 109/l or the presence of more than 10% immature neutrophils Septic shock Sepsis induced hypotension (systolic blood pressure < 90 mm Hg or a reduction of >40 mm Hg from baseline) despite adequate fluid resuscitation Multiple organ dysfunction syndrome Presence of altered organ function in an acutely ill patient...
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...guidelines (SSG), an update to the 2008 guidelines for early identification and management of sepsis in adults.1 The guidelines highlight the importance of screening every potentially infected patient for sepsis and providing best-practice interventions for managing sepsis, severe sepsis, and septic shock. This article provides an overview of care for the adult patient with sepsis, focusing on sepsis identification and the first 6 hours of goal-directed treatment according to current guidelines. Defining sepsis Sepsis is the presence of infection along with systemic manifestations of infection. If sepsis isn’t recognized and treated early, it progresses rapidly to severe sepsis, defined as sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion. Sepsis-induced tissue hypoperfusion is defined as infection-induced hypotension, elevated lactate level, or oliguria.1 24 l Nursing2014 l April Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. www.Nursing2014.com D VOUGAO/iSTOCK sepsis www.Nursing2014.com April l Nursing2014 l 25 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Patients with severe sepsis may have low systolic or mean arterial pressure (MAP), a lactate level above 2 mmol/L, or a urine output of less than 0.5 mL/kg/hr for at least 2 hours despite adequate fluid...
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...I. INTRODUCTION A. Number of cases/Statistic data of the disease A.1 Statistics Accurate pre-eclampsia statistics are difficult to obtain because the condition ranges from extremely mild to severe. Mild cases are sometimes not included in official figures. Furthermore, mild cases may have no effect on pregnancy, which is why the figures for pre-eclampsia as a whole are higher than for those that actually complicate pregnancies. Around 10% of pregnant women develop pregnancy-induced hypertension (high blood pressure) or pre-eclampsia (high blood pressure with protein in the urine).Worldwide more than four million women per year will develop pre-eclampsia, and over 63,000 maternal deaths are due to pre-eclampsia. Action on Pre-Eclampsia estimates that every year in the UK pre-eclampsia is responsible for the deaths of six mothers and 500 to 600 babies. A 2005 to 2006 study showed a promising fall in the numbers of women developing eclampsia since 1992, from 4.9/10,000 to 2.7/10,000. This has arisen as a result of the introduction of management guidelines for eclampsia and pre-eclampsia. Pre-eclampsia is much more common in first pregnancies, and there is a reduced incidence of pre-eclampsia in the second pregnancy. The risk of women who have had pre-eclampsia developing it again in future pregnancies is 16 percent, and 25 percent if they suffered from severe pre-eclampsia, eclampsia or they delivered pre-term. This rises to 55 percent if their baby was delivered before...
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...because you can have it for years without knowing it. It is a leading cause of heart attacks, strokes and chronic kidney disease. Controlling high blood pressure reduces the risk of these complications. High blood pressure can often be controlled by losing excess weight, exercising more, not smoking and cutting down on salt. I I I What is blood pressure? Blood pressure is measured with a blood pressure cuff that is wrapped around your upper arm. The person taking your blood pressure (you can learn to do it yourself) pumps air into the cuff and then slowly lets it out while listening for the sound of your pulse. The top number in your blood pressure reading is called the systolic pressure and the bottom number is called the diastolic pressure. Your reading might be 120/80, which is said as “120 over 80.” The top number is the pressure when your heart beats. The bottom number is the pressure when your heart rests between beats. 2 NATIONAL KIDNEY FOUNDATION What is high blood pressure? High blood pressure (also known as hypertension) occurs when the force of your blood against your artery walls increases enough to cause damage. A single high reading may not mean that you have high blood pressure. A diagnosis of high blood pressure should always be confirmed on followup visits to your doctor or clinic. Normal blood...
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...Case Study Two: HTN, CKD, & Hypothyroidism Managing Co-Morbidities in Primary Care Primary care providers treat many patients with co-morbidities. It is important for primary care providers to utilize the most current evidence-based research and guidelines to treat and manage patients with co-morbidities in order to reduce risk factors and improve overall health. The following case study will be utilized to apply current guidelines for the treatment and management of hypertension (HTN), chronic kidney disease (CKD) and hypothyroidism including patient education, monitoring, and clinical end points. Case Study A 45 year old African American male returns for a six month follow-up for blood pressure (BP) control. The patient complains of on-going symptoms over the past few months of dry cough, sleep disturbances, fatigue, constipation, weight gain, and dry skin. The patient denies pain, shortness of breath, edema, or sputum production. Pulse is 80 and regular, BP is 148/110, and BMI is 28. He is six feet tall and weighs 205 pounds. Labs reveal TSH of 5.2, free T4 of 0.8, free T3 1.8, Creatinine 2.1, BUN 22. Family history includes stroke, heart attack, and high cholesterol. Current medications are daily multivitamin, Lisinopril 10 mg once daily, over-the-counter (OTC) Robitussin, and OTC laxative as needed (University of Phoenix, 2014, Week Seven Case Study). The patient can be diagnosed with uncontrolled HTN, subclinical hypothyroidism, and may have chronic kidney...
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