Discussion Question Realistic plan

1-Discussion Question: 56-year-old patient with newly diagnosed stage 1 hypertension has been referred to you for counseling regarding lifestyle modifications. He is married, with four children—two in high school, two in college. His job as a senior vice-president for a major retail chain requires that he work long hours and frequently eat at restaurants. He smokes two packs of cigarettes a day, has a body mass index (BMI) of 29 kg/m2, and a waist–hip ratio of 1.6. He usually drinks one to two dry martinis to relax after he gets home from work.

a. How would you develop a realistic plan to help this patient reduce his blood pressure and prevent complications?

b. Which risk factors would be among your top two or three priorities for this patient,and what interventions or recommendations would you provide for modifying these?

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Cardiac Conduction System

Controls the rate and direction of electrical impulse conduction in the heart

Impulses are generated in the SA node, which has the fastest rate of firing, and travel to the Purkinje system in the ventricles.

In certain areas of the heart, the myocardial cells have been modified to form the specialized cells of the conduction system.

The conduction system maintains the pumping efficiency of the heart.

Phases of Cardiac Potentials

Phase 0: rapid upstroke of the action potential

Phase 1: early repolarization

Phase 2: plateau

Phase 3: final repolarization period

Phase 4: diastolic repolarization period

Refractory Periods #1

Absolute Refractory Period

No stimuli can generate another action potential.

Includes phases 0, 1, 2, and part of phase 3.

The cell cannot depolarize again.

Relative Refractory Period

Greater than normal stimulus response

Repolarization returns the membrane potential to below the threshold, although not yet at the resting membrane potential.

4 Discussion Question Realistic plan

Refractory Periods #2

Begins when the transmembrane potential in phase 3 reaches the threshold potential level

Ends just before the terminal portion of phase 3

Supernormal Excitatory Period

A weak stimulus can evoke a response.

Extends from the terminal portion of phase 3 until the beginning of phase 4

Cardiac arrhythmias develop.

Electrocardiography

Twelve leads

Diagnostic ECG

Each providing a unique view of the electrical forces of the heart

Diagnostic criteria are lead specific.

Improper lead placement can significantly change the QRS morphology.

Misdiagnosis of cardiac arrhythmias or the presence of conduction defects can be missed.

Goals of Continuous Bedside Cardiac Monitoring

Shifted from simple heart rate and arrhythmia monitoring to

Identification of ST segment changes

Advanced arrhythmia identification

Diagnose

Provide treatment

Question #1

Is the following statement true or false?

The electrocardiogram is a reflection of cardiac muscle contraction. You can directly diagnose specific defects in muscle activity.

Answer to Question #1

False

Rationale: The electrocardiogram is a reflection of cardiac muscle contraction. You can directly diagnose specific defects in muscle activity.

Types and Causes of Disorders of the Cardiac Conduction System

Types

Disorders of rhythm

Disorders of impulse conduction

Causes

Congenital defects or degenerative changes in the conduction system

Myocardial ischemia and infarction

Fluid and electrolyte imbalances

Effects of drug ingestion

Types of Arrhythmias #1

Sinus Node Arrhythmias

Sinus bradycardia

Sinus tachycardia

Sinus arrest

Arrhythmias of Atrial Origin

Paroxysmal supraventricular tachycardia

Atrial flutter

Atrial fibrillation

Types of Arrhythmias #2

Junctional Arrhythmias

Disorders of Ventricular Conduction and Rhythm

Long QT Syndrome and Torsades de Pointes

Ventricular Arrhythmias

Premature ventricular contractions

Ventricular tachycardia

Ventricular flutter and fibrillation Discussion Question Realistic plan