Question

Case Study: You are a nurse working in an emergency department. Your new admission is a 22 year-old-male brought in by the paramedics after fainting during a try out session for his university's competitive hockey team. The patient states he was experiencing some chest pain and dizziness right before fainting. He denies having any past medical history or taking any medication. His vital signs at the time the paramedics arrived at the scene were the following: blood pressure 80/55mmHg, heart rate 123 beats/min, saturation 98%, respiration rate 22 and temperature 37 degrees Celsius. On arrival to the emergency department, an electrocardiogram (ECG) and cardiac ultrasound are performed. The ECG shows ventricular tachycardia with wide QRS complexes and the ultrasound shows right ventricular wall thickening. The cardiology team confirms the diagnosis of hypertrophic cardiomyopathy. Question 1: In the article, the authors state that cardiac wall thickening can be a normal adaptation process in a healthy person who engages in regular intense exercise. Explain why cardiac wall thickening would be beneficial for a per son during intense physical activity? In your answer, provide information about the physiological and cellular changes that occur in the myocardium of an athlete. 5 points Question 2: Considering the information provided in the case study, which following factor (preload, afterload, myocardial contractility and heart rate) could explain the patient's drop in blood pressure? Explain your reasoning using the following formula CO (cardiac output) = HR (heart rate) x SV (stroke volume). 5 points Question 3: A first year emergency medical resident gives you a verbal order for a IL normal saline bolus to be given to the patient to increase his blood pressure. A senior nurse who overheard the verbal order jumps in and tells you "You might want to check with the attending physician if he agrees with that prescription. Giving the patient a IL bolus will not treat the underlying cause of the hypotension". Explain why the senior nurse's assumption is likely correct, and what further complications could arise as a result of following the resident's order? 4 points Question 4: The cardio logy team decided that the patient would require the insertion of an implantable defibrillator. His family is concerned that he will no longer be able to qualify for athletic events. Using layman terms, briefly explain to the patient and his family why this is no long er the 2 points case.

Please provide detailed explanation for each answer. Thanks

Answer 1

1. Left ventricular hypertrophy facilitate the generation of a large and sustained cardiac output to counteract the oxygen deficit building in the skeletal muscles. This hypertrophy is as a result of increase in cardiac myocyte size but not because of increase in number of cells. This enlargement is fundamental to the ability to generate a large stroke volume. This physiologic growth is accompanied by increases in energy production capacity, primarily mitochondrial.

2.Heart size increases in athletes so as to pump more blood. Pumping more blood in blood capillaries activates circulatory reflex so resting heart rate decreases in athletes .as a result Np also drops down. Because cardiac output=heart rate*stroke volume

3. as in athletes, low bp is not because of hypovolemia but due to enlarged left ventricle. Therefore providing fluid will just overburden the heart.

4.I will try to convince his parents that it is not case . He still can participate in sports. Implantable defibrillators are just a device to keep patient heart rhythm normal by giving shock whenever required . So ther is no need to worry regarding his future participation in sports .