A 32-year-old nurse asks a colleague to take her vitals, as she keeps having episodes of light-headedness, chest pain, and fast heart rate (tachycardia) during the shift, especially after frenetic events in the emergency room (ER) that involve her moving around rapidly. By the end of the shift she would also have swelling in the ankles and feet. Her colleague takes her vitals and notes that her blood pressure (BP) is low, and suggests that she get it checked. Her PCP determines her resting to be 100/58 mmHg. He also heard an additional heart sound when performing auscultation of the chest in the fourth to fifth intercostal space over the mitral valve. In her medical history, it was noted that she had a number of strep throat infections as an adolescent. She was referred to a cardiologist for full assessment. Complete cardiac examination involved an echocardiogram to visualize the heart valves, and ECG to check the timing of the rhythm, and a chest x-ray. The chest x-rays showed an enlarged left atrium and left ventricle, and there was also mild pulmonary congestion. The ECG analysis showed some atrial fibrillation. To fully assess the internal damage and get the most accurate images of the heart, catheterization was used. The procedure is also considered the gold standard for acquiring the most accurate pressure measurements in the chambers of the heart, especially the left atrium and ventricle. Doppler echocardiography was used to determine the CO. Cardiac output (CO) Blood pressure (BP) Left atrial pressure (LAP) Left ventricular pressure (LVP) NORMAL (4–8 l/min) (120/80 mmHg) (6–12 mmHg) 3.4 l/min 100/58 mm Hg 25 mm Hg 115/6 mmHg The pressure gradient from the atria to the ventricle during diastole is greatly elevated on the left side (19 mmHg vs. 1-3 mmHg normally). The left atrial volume was also increased. The patient was put forward for surgery to repair the defect, and was prescribed a diuretic and antiarrhythmic in the interim period.
A 32-year-old nurse asks a colleague to take her vitals, as she keeps having episodes of light-headedness, chest pain, and fast heart rate (tachycardia) during the shift, especially after frenetic events in the emergency room (ER) that involve her moving around rapidly. By the end of the shift she would also have swelling in the ankles and feet. Her colleague takes her vitals and notes that her blood pressure (BP) is low, and suggests that she get it checked. Her PCP determines her resting to be 100/58 mmHg. He also heard an additional heart sound when performing auscultation of the chest in the fourth to fifth intercostal space over the mitral valve. In her medical history, it was noted that she had a number of strep throat infections as an adolescent. She was referred to a cardiologist for full assessment. Complete cardiac examination involved an echocardiogram to visualize the heart valves, and ECG to check the timing of the rhythm, and a chest x-ray. The chest x-rays showed an enlarged left atrium and left ventricle, and there was also mild pulmonary congestion. The ECG analysis showed some atrial fibrillation. To fully assess the internal damage and get the most accurate images of the heart, catheterization was used. The procedure is also considered the gold standard for acquiring the most accurate pressure measurements in the chambers of the heart, especially the left atrium and ventricle. Doppler echocardiography was used to determine the CO. Cardiac output (CO) Blood pressure (BP) Left atrial pressure (LAP) Left ventricular pressure (LVP) NORMAL (4–8 l/min) (120/80 mmHg) (6–12 mmHg) 3.4 l/min 100/58 mm Hg 25 mm Hg 115/6 mmHg The pressure gradient from the atria to the ventricle during diastole is greatly elevated on the left side (19 mmHg vs. 1-3 mmHg normally). The left atrial volume was also increased. The patient was put forward for surgery to repair the defect, and was prescribed a diuretic and antiarrhythmic in the interim period.
Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
Problem 1SRQ
Related questions
Question
a. how can the cardiac output be compensated, and what has failed here.
b. What is the diuretic aiming to achieveand what is the most likely nature of the surgical repair based on the severity of the issue and the
age of the patient
Transcribed Image Text:A 32-year-old nurse asks a colleague to take her vitals, as she keeps having episodes of light-headedness, chest pain,
and fast heart rate (tachycardia) during the shift, especially after frenetic events in the emergency room (ER) that
involve her moving around rapidly. By the end of the shift she would also have swelling in the ankles and feet. Her
colleague takes her vitals and notes that her blood pressure (BP) is low, and suggests that she get it checked. Her PCP
determines her resting to be 100/58 mmHg. He also heard an additional heart sound when performing auscultation
of the chest in the fourth to fifth intercostal space over the mitral valve. In her medical history, it was noted that
she had a number of strep throat infections as an adolescent. She was referred to a cardiologist for full assessment.
Complete cardiac examination involved an echocardiogram to visualize the heart valves, and ECG to check the
timing of the rhythm, and a chest x-ray. The chest x-rays showed an enlarged left atrium and left ventricle, and
there was also mild pulmonary congestion. The ECG analysis showed some atrial fibrillation. To fully assess the
internal damage and get the most accurate images of the heart, catheterization was used. The procedure is also
considered the gold standard for acquiring the most accurate pressure measurements in the chambers of the heart,
especially the left atrium and ventricle. Doppler echocardiography was used to determine the CO.
NORMAL
Cardiac output (CO)
Blood pressure (BP)
Left atrial pressure (LAP)
Left ventricular pressure (LVP)
3.4 l/min
100/58 mm Hg
25 mm Hg
115/6 mmHg
(4-8 l/min)
(120/80 mmHg)
(6–12 mmHg)
The pressure gradient from the atria to the ventricle during diastole is greatly elevated on the left side (19 mmHg
vs. 1-3 mmHg normally). The left atrial volume was also increased. The patient was put forward for surgery to
repair the defect, and was prescribed a diuretic and antiarrhythmic in the interim period.
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