...An Introduction to the 12 lead ECG & Acute MI changes a lecture for student nurses Dr Kofi Amu-Darko MB. ChB. DRCOG. DFFP. MRCGP. PgDip. LLM Family Physician Charles Curtis Memorial Hospital October 2008 1 By the end of this lecture, you will be able to: • Understand the 12 lead ECG in relation to the coronary circulation and myocardium • Perform an ECG recording • Identify the ECG changes that occur in the presence of an acute coronary syndrome. • Begin to recognize and diagnose an acute MI. 2 What is a 12 lead ECG? Records the electrical activity of the heart (depolarization and depolarization of the myocardium) Views the surfaces of the left ventricle from 12 different angles 3 Anatomy and Physiology Review A good basic knowledge of the heart and cardiac function is essential in order to understand the 12 lead ECG Anatomical position of the heart Coronary Artery Circulation Conduction System 4 Anatomical Position of the Heart Lies in the mediastinum behind the sternum between the lungs, just above the diaphragm the apex (tip of the left ventricle) lies at the fifth intercostal space, mid- clavicular line 5 6 Coronary Artery Circulation Right Coronary Artery right atrium right ventricle inferior wall of left ventricle posterior wall of left ventricle 1/3 interventricular septum 7 Coronary Artery Circulation Left Main Stem Artery divides in two: Left Anterior...
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...a coronary artery or one of its smaller branches is suddenly blocked. The part of the heart muscle supplied by this artery loses its blood (and oxygen) supply if the vessel is blocked. This part of the heart muscle is at risk of dying unless the blockage is quickly removed. When a part of the heart muscle is damaged it is said to be infarcted. The term myocardial infarction (MI) means damaged heart muscle. If a main coronary arteries is blocked, a large part of the heart muscle is affected. If a smaller branch artery is blocked, a smaller amount of heart muscle is affected. After an MI, if part of the heart muscle has died, it is replaced by scar tissue over the next few weeks. What happens in dysrhythmias- A cardiac dysrhythmia is an abnormal heart beat: the rhythm may be irregular in its pacing or the heart rate may be low or high. Some dysrhythmias are potentially life threatening while other dysrhythmias (such as sinus arrhythmia) and normal. Tachycardia is a fast (over 100 beats per minute) heart rhythm. Tachycardias can originate in the atria or ventricles. * Dysrhythmias that originate in the atria are termed supraventricular dysrhythmias (supraventricular means above the ventricles). These...
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...Case Study: Coronary Disease Laura Kwan Past Medical History: - tonsils removed as a child - no regular medication - takes reloads occasionally Family Medical History: - father died of myocardial infarction at age 52 - mother is 73 and in good health Social History: - moderately heavy social drinker - 2-3 beers after work - 5-6 beers per day on weekends - smokes a pack of cigarettes a day - married with two children - finances are stable History of Present Illness: - woke up at 4am with pressure in his chest, described as “worst indigestion I ever had” - sweaty and slightly short of breath - achy, heavy feeling in his right arm - ate pizza before bed (unhealthy) - took four Rolaids initially - didn't bring any relief - sitting made the pressure settle down - he was clammy - pressure on his chest persistently for approximately two hours - put on oxygen mask - nurses concerned about his EKG - EKG showed 1 cm ST elevation on leads V2,3,4,5 with slight ST depression on leads 2,3 and AVF Physical Examination: - heart rate was 110 (high heart rate) - respiratory rate was 22 (high respiratory rate. Should be 16-20) - blood pressure was 160/100 (high bp) - sweaty, pale, and had no obvious jugular venous distention - chest was clear on auscultation - abdomen was unremarkable - skin was slightly sweaty - chest x-ray was normal with normal heart size - lab work was normal Research: Heart Problems - closely linked to diet and lifestyle choices ...
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...and short of breath. He is complaining of chest pain radiating to his left arm. This is Peter’s first presentation to hospital and he has no relevant past medical history. Peter smokes approximately 20–30 cigarettes per day and takes alcohol at weekends only. Peter is anxious and is concerned that his wife and children are informed. He also states his father died suddenly following a heart attack a number of years ago. Peter is immediately triaged and taken to the resuscitation room. You are the receiving nurse. Observations on admission include: Respiratory rate: 18 breaths per minute Oxygen saturations: 95% Blood pressure: 150/90 mmHg Pulse: 94 beats per minute Temperature: 37ºC. On admission to hospital an electrocardiograph (ECG) has been undertaken. Peter has been diagnosed with an anterior ST segment elevation myocardial infarction (anterior STEMI). Blood samples have also been drawn for urea and electrolytes (U&E), full blood picture (FBP) and highly sensitive troponin T. 1 Discuss Peter’s immediate problems and explain these using your knowledge of pathophysiology. A On admission to Accident and Emergency (A&E), Peter will be assessed using the Manchester Triage system (Cooke and Jinks 1999) incorporating the ABCDE approach as per the Resuscitation Council (UK) (2011). The ABCDE assessment and management tool can be applied to all deteriorating or critically ill patients. It is recognized that approximately 30 per cent of people developing...
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...The aim of this essay is to explore an acute deterioration in the health of an adult I have encountered during a clinical placement, in an acute care setting. The essay will begin with a definition of acute care, followed by the introduction of my patient and predisposing factors. This essay will include an explanation of the significant pathophysiological changes and related clinical manifestations and a critical analysis of the nursing interventions implemented during the acute episode of care, focusing on holistic care, rationale and evidence base. It will then describe the actual deterioration in the patient’s condition, and discuss the nurse’s role in the recognition and assessment of the actual deteriorating condition following the trusts policies. Assessment tools, monitoring, detecting and reporting will be considered. Finally this essay will include a discussion of the importance of multidisciplinary team collaboration in the diagnosis and provision of care during the acute episode, and a discussion on whether the deterioration could have been prevented by identifying any areas of practice which could change in relation to evidence based practice. For the purposes of privacy and confidentiality, in accordance with NMC (2008) code of conduct, the name of the patient will be changed to Peter and the placement area will remain as an acute care setting. According to McFerran (2008) the term “acute” is described as a disease of rapid onset, severe symptoms, and brief duration...
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...variation. In this case the cause of the exacerbation is CAP which has made it even more difficult for the patient to mobilize air for effective gas exchange. Differential diagnoses Heart failure. Heart failure (HF) was considered a differential diagnosis since common signs and symptoms of HF such as dyspnea, orthopnea, fatigue, and weakness were mentioned in the patient’s HPI. According to Colucci (2014) the patient’s history and physical, ECG, BNP, and chest x-ray are used to diagnose a patient with HF. Additionally, Colucci (2014) recommends that for a male patient with suspected HF who is symptomatic and has a history of myocardial infarction (MI), or basal crepitation (crackles), or ankle edema, an echocardiography should be performed to evaluate the patient’s hemodynamics and search for potential cases of HF. Mr. XX’s has no history of MI. During physical exam no edema was present, but crackles were auscultated and an echocardiography was ordered. Jugular venous pressure was not elevated, S3 or S4 were not present, and PMI was not displaced. ECG results were normal. BNP was below 100, which represents a normal value. Chest x-ray showed no cardiomegaly and the cardiac silhouette was normal. Finally, the echocardiography revealed no signs of HF, thus ruling out the diagnosis. Acute coronary syndrome. Acute coronary syndrome (ACS) is an umbrella term that includes: Unstable angina (UA), non ST-Elevation myocardial infarction (NSTEMI), and ST-Elevation myocardial infarction (STEMI)...
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...Organizational Systems RTT Task 2 Allison Vargus Western Governor’s University Organizational Systems RTT Task 2 Questions A The main goal of Root Because Analysis is to identify the policies and procedures in an agency that can be changed for the better. These changes are identified within an organization and a plan is put into place to prevent any reoccurrences of negative outcomes. RCA is defined as a “process for identifying the basic or casual factors that underlie variation in performance, including the occurrence of a sentinel event; it focuses primarily on systems and processes, not individual performance” (Cherry and Jacon, 2011, p. 442). A multidisciplinary team must assemble and pinpoint the exact causation of the problems. After the issues have been identified the next step is to determine refinements to prevent them from occurring again. Mr. B arrived at the Emergency Room after he had a fall in his home. The sixty-seven-year-old man arrived to the 6 bed, small town ER with his son and neighbor in a severe amount of pain in his left hip and leg area. There are several unfortunate reasons that lead to Mr. B’s demise. The information gathered to complete the RCA will determine the causation of this ill-fated situation. I will discuss these factors in further detail ahead. The first factor in this case I will discuss is the lack of education on hospital policies and procedures. Mr. B was placed under conscious sedation and therefore he should have...
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...irritable and anxious; he complains of sleeping poorly and states that lately feels tired most of the time. His vital signs (VS) are 162/84, 124 HR, 36 RR, 102 degrees F, Sao2 88%. His admitting diagnosis is an acute exacerbation of chronic emphysema. Chart View Physician’s OrdersDiet as toleratedOut of bed with assistanceOxygen (O2) to maintain Sao2 of 90%IV of D5W at 50 ml/hrECG monitoringArterial blood gases (ABGs) in AMCBC with differential nowBasic metabolic panel (BMP) nowChest x-ray (CXR) q 24 hrs. Sputum cultureAlbuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT | 1. Explain the pathophysiology of emphysema. Emphysema is characterized by destruction of the walls of the alveoli, with resulting enlargement of abnormal air spaces. Deficiency of a₁-antitrypsin contributes to the development in some individuals, especially when combined with exposure to cigarette smoke (Pearson, 1006). 2. Are D.Z.’s vital signs and Sao2 appropriate? If...
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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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...suffering symptoms of acute alcohol withdrawal syndrome (acute confusion, delusions and tremors). This arises when an individual reduces or stops alcohol consumption after prolonged periods of excessive alcohol intake. This can lead to tolerance, physical dependence and physical disturbances upon withdrawal due to the central nervous system reacting in a hyper-excitable state. (About.com, 2010) He was transferred to my area when his Implantable Cardioverter Defibrillator (ICD device) was found to be infected (indications being inflammation, tenderness, exudates, and Sensitive Staphylococcus aureus grown from wound swabs). An ICD device is implanted within those suffering an arrhythmia and/or at high risk of its development. Arrhythmias are abnormal electrical impulses differing from the normal Sinus Rhythm....
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...Stroke Case Study Scenario: You are at base when you get dispatched code 4 to 100 Me She Ka St, Christian Island, Ontario for a 75 y/o female patient possible CVA. On arrival you find a frantic husband stating the patient (his wife) was making breakfast when she suddenly collapsed. The symptoms started 10 minutes prior to calling 911. The patient is suffering from left sided paralysis with slurred speech. She lives on Christian Island and needs to take a ferry to get to the nearest hospital. She has a history of atrial fibrillation and TIA’s, and the patient also smokes 2 packs of cigarettes a day. She’s on ASA, digoxin, ramipril, metoprolol. She has an allergy to penicillin and bee stings. The patient shows a-fib on the monitor and vital signs and GCS are normal. Pupils are PEARL at 3mm. Patient name: Myrtle Bellamee Birthday: 1938/01/10 Health card number: 1284569735 VR Treatment with the Ontario Stroke Strategy The Ontario Stroke System (OSS) is a comprehensive and integrated approach that aims to decrease the incidence of a stroke and improve patient care and outcomes for those who’ve experienced a stroke. The treatment plan that Mrs Myrtle Bellamee would have been on before this incident would be a very common strategy due to her history of cerebrovascular accident (CVA) or a stroke, atrial fibrillation and her previous transient ischemic attack (TIA). She would have been on a low dose antiplatelet...
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...COPD All respiratory diseases characterized by chronic obstruction to airflow fall under the broad classification of COPD, also known as chronic airflow limitations (CAL). COPD is a condition of chronic dyspnea with expiratory airflow limitation that does not significantly fluctuate. Within that broad category, the primary cause of the obstruction may vary; examples include airway inflammation, mucous plugging, narrowed airway lumina, or airway destruction. The term COPD includes chronic bronchitis and emphysema. Although asthma also involves airway inflammation and periodic narrowing of the airway lumina (hyperreactivity), the condition is the result of individual response to a wide variety of stimuli/triggers and is therefore episodic in nature with fluctuations/exacerbations of symptoms. Asthma: Also known as chronic reactive airway disease, asthma is characterized by reversible inflammation and constriction of bronchial smooth muscle, hypersecretion of mucus, and edema. Precipitating factors include allergens, emotional upheaval, cold weather, exercise, chemicals, medications, and viral infections. Chronic bronchitis: Widespread inflammation of airways with narrowing or blocking of airways, increased production of mucoid sputum, and marked cyanosis. Emphysema: Most severe form of COPD, characterized by recurrent inflammation that damages and eventually destroys alveolar walls to create large blebs or bullae (air spaces) and collapsed bronchioles on expiration (air-trapping)...
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...Should Athletes be Screened Better for Heart Defects? By Margaret Anne Rich A Research Project Proposal Submitted to the Graduate School of Northwestern State University of Louisiana In partial fulfillment of the requirements for the Master of Science in Health and Human Performance With concentration in Sport Administration April 2013 Abstract The purpose of this study is to determine if college athletes that are predisposed to heart defects develop a heart defect during their athletic career. The researcher will conduct a causal comparative study to prove that college athletes that are predisposed to heart defects develop one during their athletic career. The study will examine college athletes that are predisposed to heart defects and do not realize they are at risk for possible development of a heart defect during their athletic career. Knowing an athlete’s family and medical history could help prevent a great deal of possible health conditions. Athletes have a higher risk of developing a higher risk if they are predisposed. There are athletes that do not realize that they are predisposed to heart defects and that they could develop one. Table of Contents Introduction 5 Background 5 Theoretical Framework 6 Statement of the problem. 6 Research question. 6 Purpose for the study. 7 Significance 7 Limitations of the Study 7 Definitions of Terms 8 Arrhythmias 8 Athletic Career 8 Electrocardiogram 8 Hypertrophic cardiomyopathy:...
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...is severely reduced or stopped. This happens when one of the arteries that supply blood to the heart muscle is blocked by an obstruction. This blockage can be due to a condition called atherosclerosis (a buildup of fatty like substance along the wall of the artery), a blood clot or a coronary vessel spasm along with a total obstruction. If the blood supply to a portion of the heart stops, that area of the heart will no longer receive the oxygen or nutrients needed to carry out its function and will die. If it is a very small part of the heart involved, it will be able to work without it. If a large portion is damaged, irreversible damage will happen which can lead to death. Damage to the heart muscle may be so severe that it may cause abnormal heart rhythm, called arrhythmias. Most people who are of a myocardial infraction or a heart attack do so within a few hours due to a type of arrhythmia. The heart attack victim will complain of pressure, discomfort or a squeezing sensation in the center of the chest. There may be pain radiating to the arms or the neck. There may also be shortness of breath, weakness, fatigue, nausea, vomiting and or indigestion. The pain that occurs is the result of heart tissue ischemia (decreased blood supply). The area that is not receiving enough blood is literally crying out for help. When a person complains of any of the symptoms mentioned, they should be transported to the nearest hospital. The diagnosis of an M.I. is made for the patient's history...
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...weeks to become an infected larva. When the mosquito feeds on another animal the microfilariae is passed to that animal. There the microfilariae the larva develops over three to six months, and migrate to the right side of the heart. About six months the larva develops into an adult worm. The adult worm can live up to seven years, and produce microfilaria which completes the life cycle. Heart worms a very serious health issue. Which can lead to right ventricular dilation, hypertrophy, heart failure, and death. Clinical signs can occur within six months or latter from the time on infected. The physical signs can be very mild to severe depending on the number of adult worms present. Which can range from coughing, difficulty breathing, and abnormal heart sounds to death. There are several tests that could be done to diagnosis heartworm disease. The oldest way knots test, but it is still used in some clinics. Which few drops of blood are passed through a fine filter which traps any microfilariae passed through it. Then a drop of stain is applied to the filter which outlines the microfilaria, and viewed under a microscope at 100x-400x magnification. These days we use an Elisa test which...
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