Exercises: (10 Points Each) How

Exercises: (10 Points Each)

How do heart rate, preload, afterload, and contractility affect cardiac output and cardiac workload?

Heart rate is how fast the heart is working. Preload and afterload is how much blood ingests and ejects while pumping and contractility is the ability of the heart to act as a pump. If any of those is compromised or significantly altered, it can cause cardiac output to be compromised and cardiac workload to rise to abnormal heights. The heart working too hard and/or inefficiently can obviously lead to problems.

How do the clinical features of the coronary heart disease syndromes differ?

They can differ based on what precise symptoms are realized, what time frame in which symptoms become apparent. Symptoms can build up over time or they may present themselves in a very sudden fashion up to and including immediate death.

How do valvular disorders alter cardiac pressure dynamics and workload?

A valvular problem can lead to the heart working harder to accomplish the same workload and this can lead to the heart wearing down or becoming damaged. Valvular issues can also cause cardiac pressure to spike and this wreaks havoc as well.

4. How do the compensatory responses triggered in CHF work to restore cardiac output?

The sympathetic nervous system kicks in and this leads to improved contractility in the heart. The kidney retains sodium and water at the kidney and this increases blood volume and preload. Angiotensin II is also activated and this shunts blood to vital organs.

5. What is the clinical significance, characteristic electrocardiographic features, and usual treatment of each of the common cardiac dysrhythmias?

Atrial fibrillation is usually treated using either drugs, abalation or surgery. Atrial flutter is usually treated with only ablation. Supraventricular tachycardia are hard to control with medication so ablation is usually done. Ventricular fibrillation usually has to be treated with a defibrillator. Ventricular tachycardia is usually treated with a combination of medication, a defibrillator and/or ablation.

Professional Development (20 points each)

From the Brashers textbook, please complete the following case studies:

1. Chapter 1: Hypertension

Question 1

It should be asked if there is a family history of hypertension, heart disease or stroke. The patient should be asked for certain to confirm that no symptoms like dizziness, blurred vision, shortness of breath, swelling, pale skin, etc. are present. The patient should be asked to confirm any prior surgeries, disorders, or sicknesses.

Question 2

The patient should be asked if they smoke cigarettes at all, use any form of recreational drugs or drink, especially to excess on any of those three items. The patient should be asked if there have been any weight gains over the recent past. The patient should again confirm whether and what other symptoms may be present. The patient might be obscuring the truth and may be in denial that something is quite possibly wrong.

Question 3

If the total cholesterol figure is accurate, it is on the high side and it is extremely likely that bad cholesterol (LDL) is on the high side. Regardless, the total cholesterol and ratio of good to bad should be checked. The patient drinks a little more than he probably should be and needs to drop it down or cut it out entirely. The patient is obese and his weight is trending upward. Both of those facts are indicative of problems.

Question 4

Positive signs include a good pulse, the patient is not in obvious distress and breathing capacity seems to be solid. Bad signs include blood pressure being very high despite the patient being at rest and the patient is overweight.

Question 5

There are no obviously acute symptoms in play but the patient needs to make some major lifestyle changes immediately. This is especially true given the medical history on the paternal side. The patient should drink less, participate in more physical activity and should eat a better diet. The blood pressure and cholesterol both need to come down immediately.

Question 6

The patient needs to take the recommendations in question 5 or he likely has a very dim future if his BP and cholesterol is not lowered a lot. Blood pressure should be measured after the patient has rested for at least five minutes. He should be instructed in advance of the appointment what not to eat or drink so that the test result is not improperly influenced (e.g. drinking caffeine).

Question 7

There is no advancement or progression in symptoms but blood pressure is still entirely too high. It needs to drop by at least 30 points to be within a non-hypertension range. Needs to be made clear to patient that while he is feeling fine for now, that will change if the proper lifestyle changes are not made.

Question 8

A full batter of blood work should be done to get the full picture of what is really going in with the patient. A urinalysis should also be done because that could be instructive as well.

Question 9

The cholesterol is indeed out of whack. The good amount is too low and the bad amount is too high. The QRS voltage is an indicator of LVH and is likely a precursor or symptom of heart issues based on family history and the totality of the symptoms.

Question 10

The lifestyle changes named earlier are now urgent and the patient should be monitored for blockages in arteries as well as heart scans/analysis to find out what, if anything, is systemically or physically wrong with the function and structure of the heart.

2. Chapter 4: Heart Failure

Question 1

There are multiple symptoms in play here that are indicative of congestive heart failure. Specifically, the swelling in the hands and feet, the consistent shortness of breath, the patient's age and the fatigue he is having.

Question 2

The edema in the feet and ankles is not a good sign and it extends up to the calf. The pulse is a bit weak and the patient's strength is not optimal although that is not entirely surprising given the age of the patient. The cool and pale skin is also not a good sign.

Question 3

A full battery of tests should be done including full blood work, a urinalysis test, a chest radiograph and an electrocardiogram. All of these are relevant, each for their own reasons.