...intake. The genomic effect of aldosterone increases renal sodium transport, but the administration of large doses of aldosterone to normal individuals does not cause edema, relating to the phenomenon of "aldosterone escape"; however, in edematous disorders including cardiac failure, cirrhosis, and nephrotic syndrome, impaired aldosterone escape leads to renal sodium retention and edema formation. There is now considerable evidence for the nongenomic effects of aldosterone in several important diseases. Thus, low dosages of mineralocorticoid antagonists, with little or no effect on urinary sodium excretion, have been shown to afford a beneficial effect on morbidity and mortality in patients with advanced cardiac failure and after acute myocardial infarction. Three-drug-resistant hypertension has also been found to respond to spironolactone in modest dosages. The combination of an angiotensin converting enzyme inhibitor (ACEI) with spironolactone to treat such resistant hypertension may be more effective than adding an angiotensin receptor blocker to an ACEI. The role of spironolactone has also been shown to decrease albuminuria in chronic kidney disease including diabetic nephropathy in the presence of maximal dosages of ACEI. The effect of aldosterone in metabolic...
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...Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study Summary Background Although more than 80% of the global burden of cardiovascular disease occurs in low-income and middle-income countries, knowledge of the importance of risk factors is largely derived from developed countries. Therefore, the effect of such factors on risk of coronary heart disease in most regions of the world is unknown. Methods We established a standardised case-control study of acute myocardial infarction in 52 countries, representing every inhabited continent. 15152 cases and 14820 controls were enrolled. The relation of smoking, history of hypertension or diabetes, waist/hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins (Apo), and psychosocial factors to myocardial infarction are reported here. Odds ratios and their 99% CIs for the association of risk factors to myocardial infarction and their population attributable risks (PAR) were calculated. Findings Smoking (odds ratio 2·87 for current vs never, PAR 35·7% for current and former vs never), raised ApoB/ApoA1 ratio (3·25 for top vs lowest quintile, PAR 49·2% for top four quintiles vs lowest quintile), history of hypertension (1·91, PAR 17·9%), diabetes (2·37, PAR 9·9%), abdominal obesity (1·12 for top vs lowest tertile and 1·62 for middle vs lowest tertile, PAR 20·1% for top two tertiles vs lowest tertile), psychosocial...
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...explore the applications of stem cells while avoiding the ethical problems associated with embryonic stem cell research (Seki & Fekuda, 2015). One intriguing area in stem cell research is the potential applications for them in the treatment of cardiac diseases. Studies have explored the potential uses for stem cells for the treatment of heart disease (Yamakawa & Ieda, 2015). Additionally, stem cells have been explored for the treatment of heart failure and myocardial infarction (Rasmussen, et al., 2013). Stem cells and how they may be used for the treatment of various cardiac diseases is an exciting topic and has the potential to change future approaches to the treatment. This paper will examine the applications and significance of stem cells in relation to these common cardiac pathologies. Heart disease is one of the leading causes of death in developed countries and currently there are few effective treatment options available (Yamakawa & Ieda, 2015). This it is important to research and make state of the art treatments available to address this issue. The use of stem cells may become an option for treatment of coronary artery disease (CAD). One approach has involved the use of endothelial progenitor cells (EPCs). In one study, EPCs were introduced into areas affected by ischemia and have been able to generate proliferation of new...
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...Myocardial Infarction Cardiovascular disease is the leading cause of death in the United States; approximately 500,000-700,000 deaths related to the coronary artery occur each year. Approximately 1.5 million cases of myocardial infarction occur annually in the United States. Myocardial infarction, commonly known as a heart attack, is the irreversible necrosis of heart muscle secondary to prolonged ischemia. This usually results from an imbalance in oxygen supply and demand, which is most often caused by plaque rupture with thrombus formation in a coronary vessel, resulting in an acute reduction of blood supply to a portion of the myocardium. Patients with typical myocardial infarction may have the following prodromal symptoms: Intense sharp chest pain, radiation of chest pain up to neck, shoulder, jaw and down left arm, ventricular tachycardia, atrial fibrillation or flutter, Coughing, wheezing, Fever, Fatigue, chest discomfort, and Malaise. Atherosclerosis is the disease primarily responsible almost 90% of myocardial infarctions that result from an acute thrombus that obstructs an atherosclerotic coronary artery. Plaque rupture and erosion are considered to be the major triggers for coronary thrombosis. Following plaque erosion or rupture, platelet activation and aggregation, coagulation pathway activation, and endothelial vasoconstriction occur, leading to coronary thrombosis and occlusion. The damage in the myocardium is essentially the result of a tissue response that...
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...Cardiac – Coronary Artery Disease/Acute Myocardial Infarction Topic: Cardiac – Coronary Artery Disease/Acute Myocardial Infarction 1 Cardiac – Coronary Artery Disease/Acute Myocardial Infarction Table of Contents Introduction...................................................................................................................3 Patient’s profile..............................................................................................................4 Pathophysiology...............................................................................................................................5 Clinical manifestations...................................................................................................................6 Short of breath and ‘light headed’...................................................................................................6 Nauseous and uncomfortable feeling...............................................................................................6 Crushing substernal chest pain .......................................................................................................6 Modifiable and Non-modifiable risk factors.................................................................7 Laboratory tests results and ECG findings................................................................................7 ECG (Electrocardiogram)....................................................................
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...Myocardial Infarction Mortality 1.0 Introduction In the UK, about 838,000 men and 394,000 women have had a myocardial infarction (MI) at some point in their lives, (NICE clinical guideline 48, 2007). The latest statistics from the British Heart Foundation state that approximately 227,000 people suffer from an acute MI (heart attack) each year (British Heart Foundation Statistics Website). To put this figure in to perspective this equates to one person every 2 minutes. Mortality is at approximately 30% which is 68,100 deaths in the UK per year. The National Service Framework (NSF) for Coronary Heart disease (CHD) is a 10-year programme published by the Department of Health in 2000 and has set key standards for the prevention and treatment of CHD. Access to the right treatment for those who suffer from an AMI, is essential to reduce morbidity and mortality and improve clinical outcomes. People with diabetes mellitus constitute a group of patients who have a higher risk of having an MI and also a poorer prognosis post infarction. The higher death and complication rates appear to be multifactorial but a significant finding in the Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) Trial showed to reduce one year mortality by 30% (Malberg et al., 1995). It’s recommended 1.1 Primary Objective To determine the relationship between HbA1c and prognosis of patients in East Lancashire having a myocardial infarction. 1.2 Secondary Objectives To assess...
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...Introduction Myocardial infarction, more commonly known as heart attack, is the world’s leading cause of death. Approximately 30% of deaths worldwide are caused by some form of cardiovascular disease. The incidence of cardiovascular diseases is more prevalent in males, but is more fatal in females. About the Patient Rakesh* (pseudonym) is a 44-year old man of Indian heritage. He has served as a policeman for twenty-two years, and is currently married with two young children. Rakesh has lived in Malaysia his entire life, and speaks English, Malay, and Tamil with a somewhat equal level of fluency. Rakesh was at a government community clinic to get a diagnosis and treatment for some pain he had been experiencing in his upper body. The pain began the night before at around 8pm, and started as a dull, throbbing sensation in his back between the shoulder blades which would occasionally radiate out to his axillaries. Initially believing that it was just a pulled muscle or two, he did not take any action and just continued with his usual activities. Later in the night, around 10.30pm-11pm, he began feeling a sharp, stabbing pain in his chest at irregular intervals. Unable to pinpoint the origin of the pain, he had taken some Paracetamol hoping that would alleviate the symptoms. By morning, he was convinced that it could probably be more than just a few tense or pulled muscles, and that he should not postpone medical attention. The case being that the patient...
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...CASE STUDY 1 Acute coronary syndrome Patrick Gallagher Case outline Peter Brown is a 58-year-old gentleman who has experienced an episode of crushing central chest pain while at work. Peter works as a taxi driver and a colleague has taken him to the Accident and Emergency Department. On admission, Peter is sweaty, clammy, nauseated 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...
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...program was introduced, the fatal and nonfatal coronary hearth disease for men and women in 30-74 year old would decline differentially. 2. Was the MHHP a randomized or non-randomized study? It was a nonrandomized community trial with three community pairs. Two communities were selected for each pair, and they were similar in structure, size, and distance from Minneapolis. One community from each pair was chosen not randomized for comparison, and the other community for intervention....
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...Nursing care plans for Diabetes Mellitus Submitted by lifenurses on Monday, 4 January 2010 2 Comments Nursing care plans for Diabetes Mellitus, Diabetes mellitus is a disorder in which the level of blood glucose is persistently raised above the normal range. Diabetes mellitus is a syndrome with disordered metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or to a combination of insulin resistance and inadequate insulin secretion to compensate. Diabetes mellitus occurs in two primary forms: type 1, characterized by absolute insufficiency, and the more prevalent type 2, characterized by insulin resistance with varying degrees of insulin secretory defects. Diabetes mellitus is a group of metabolic diseases characterized by elevated levels of glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both (ADA], Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, 2003. Causes for Diabetes Mellitus The cause of both type 1 and type 2 diabetes remains unknown, although genetic factors may play a role. Diabetes mellitus results from insulin deficiency or resistance. Insulin transports glucose into the cell for use as energy and storage as glycogen. It also stimulates protein synthesis and free fatty acid storage. Insulin deficiency or resistance compromises the body tissues’ access to essential nutrients for fuel and storage. The resulting hyperglycemia can damage many of the...
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...Beta Blockers After Myocardial Infarction Clinical Scenario The acute care nurse practitioner on the cardiology service treats a 67 year-old-male admitted after recovering from an acute ST-Elevation Myocardial Infarction (STEMI). His risk factors include obesity, Type II diabetes mellitus, and family history. Upon exam the patient asks why he has not been started on a beta blocker yet. He explains further that when his brother had a “heart attack” in 2005, he was immediately placed on a beta blocker because the cardiologist reported how beta blockers reduce mortality after myocardial infarction (MI). The patient wants to know if a beta blocker would reduce his chance of mortality? Using the Patient-Intervention-Comparator-Outcome (PICO) format we formulated the following question. In a 67-year-old male with multiple co-morbidities with MI (P), does treatment with a beta blocker (I), compared with no beta blocker or placebo (O), reduce mortality rate (O)? Risk Factors, Incidence and Prevalence of Disease * US incidence rates of cardiovascular disease, including MI, are seen in men more than women (Alexander et al., 2007). This trend is also true in Utah ("Impact of heart," 2007). * The incidence rates of cardiovascular disease increase with age (Alexander et al., 2007). * Risk factors for cardiovascular disease include not eating enough fruits and vegetables, lack of physical exercise, smoking cigarettes and the co-morbidities of diabetes, hypertension, hyperlipidemia...
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...Case study This paper will use a case study approach to explore the registered adult nurse’s role in the holistic care, in the first 24 hours, given to patient presenting with chest pain, caused by a myocardial infarction (MI). Using clinical guidance and evidence based research. The case study will use the ABCDE assessment framework. The resuscitation council (2006) recommends that nurses should follow the ABCDE method when assessing acutely and critically ill patients as it ensures nurses quickly and accurately identify acute illness and promptly begin management of the condition/ illness (Jevon, 2010). The aim of the assessment is to determine the cause of the chest pain efficiently and prioritise care needed. The main priorities were; pain control, informing appropriate medical staff and the nurse in charge, reperfusion of myocardial tissue, managing anxiety and monitoring for complications of MI and the effects of the treatment given. A MI occurs when a coronary artery becomes occluded, most commonly by a thrombus due to the rupture of an atherosclerotic artery which results in the necrosis of myocardial tissue because of the ischemia the thrombus causes (O’Neil, 1996). For the purpose of this case study and in order to protect confidentiality and anonymity the patient used will be fictitious and given a pseudonym. However the events the case study follows are very much a reality (Edwards, 2002). Case scenario Brian, a 64 year old male, was recovering...
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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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...I Got….Myocardial Infarction 1. My initial response was to laugh because it is not a diagnosis that I thought I would ever hear. I am very slender and athletic and my cholesterol levels are all well under control. I do know that to get to the point of an MI, means that I more than likely have arteries full of plaque which ultimately leads to a sudden and extended obstruction of blood supple to myocardial tissue. My brain is already spinning in curiosity of the severity of ischemia in my left ventricle. What is even more scary to me, as a woman, is the higher risk of silent ischemia in women. Silent ischemia doesn’t produce any symptoms when the heart experiences ischemic events. So I guess after the shock wears off, that is when the “oh shit” moment is about to happen. 2. Myocardial Infarction(MI) is also known as a heart attack. MI results when the flow of oxygen rich blood to a myocardium suddenly becomes blocked. If blood flow is not restored quickly, this results in cellular death by necrosis or apoptosis. Acute MI is an important form of Coronary Heart Disease (CHD). MI can occur at any age, but the risk of frequency raises with age progression. It is estimated that MI causes more than 150,000 deaths annually in the US. The American male has a greater than 1 in 5 chance of sustaining an MI or fatal ischemic event before the age of 65. Females that are younger than 45 have a 6 fold lesser risk of MI than men of the same age, however after menopause the rate becomes...
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...The leading cause of death in the United States is heart disease, which is often manifested as a myocardial infarction (MI). One of the most damaging types of myocardial infarctions is a STsegment elevation MI (STEMI) which indicates a block of blood flow to the entire thickness of the myocardial wall. In the treatment of STEMIs, quick reperfusion has the potential to save cardiac muscle. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) reperfusion guidelines recommend a door-to-balloon time (DTBT) of less than 90 minutes for all STEMI patients presenting to percutaneous coronary intervention (PCI) capable hospitals and less than 120 minutes for those same patients presenting to non-PCI hospitals (1). The DTBT of...
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