Question

Discuss one of the following: STEMI, Non-STEMI; congestive heart failure; murmurs; ventricular tachycardia; asystole

What is a safe treatment plan for a patient with Atrial Fibrillation?

What is a safe treatment plan to reduce a patient’s bilateral lower extremities pitting edema?

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Answer 1

Ans) 1) A STEMI is a full-blown heart attack caused by the complete blockage of a heart artery. STEMI stands for ST elevation myocardial infarction. “ST elevation” refers to a particular pattern on an EKG heart tracing and “myocardial infarction” is the medical term for a heart attack.

- NSTEMI stands for Non-ST-elevation myocardial infarction. Sometimes an NSTEMI is known as a non-STEMI. A myocardial infarction is the medical term for a heart attack. ST refers to the ST segment, which is part of the EKG heart tracing used to diagnose a heart attack.

- Congestive heart failure (CHF) is a chronic progressive condition that affects the pumping power of your heart muscles. While often referred to simply as “heart failure,” CHF specifically refers to the stage in which fluid builds up around the heart and causes it to pump inefficiently.

- Heart murmur definition: a condition in which unusual sounds can be heard in the heart, sometimes as a result of a fault in its structure.

- Ventricular tachycardia is a pulse of more than 100 beats per minute with at least three irregular heartbeats in a row. It is caused by a malfunction in the heart's electrical system.

- Asystole: A condition in which the heart ceases to beat.

2) After a patient is diagnosed with atrial fibrillation, the ideal goals may include: Restoring the heart to a normal rhythm (called rhythm control) Reducing an overly high heart rate (called rate control) Preventing blood clots (called prevention of thromboembolism such as stroke).

- Drug choices for rate control include beta-blockers, verapamil and diltiazem, and digitalis as first-line agents, with consideration of other sympatholytics, amiodarone, or nonpharmacologic approaches in resistant cases.

- Beta-blockers and calcium channel blockers are first-line agents for rate control in AF. These drugs can be administered either intravenously or orally. They are effective at rest and with exertion. Intravenous diltiazem or metoprolol are commonly used for AF with a rapid ventricular response.

3) Edema refers to visible swelling caused by a buildup of fluid within tissues. When an indentation remains after the swollen skin is pressed, this is called pitting edema. The effect may also be noticeable after taking off a tight shoe or stocking. In this article, we describe who is at risk for pitting edema.

3) Treatments & Interventions for Edema:

The following precautions can help minimize the risk of developing edema in at-risk patients and to minimize complications in patients already exhibiting symptoms:

• Reduce daily sodium intake.
• Avoid tight clothing and jewelry that could constrict the affected area
• Avoid extreme temperatures.
• Keep the affected limb above your heart when possible.
• Massaging the affected area firmly (but not painfully) towards the heart can help reduce excess fluid. Consider finding a qualified physical therapist or masseuse to properly perform this procedure.
• During activity, monitor the affected limb for any change in size, shape, tissue, texture, soreness, heaviness, or firmness.
• Pay particular attention to the limb during air travel, as the decrease in pressure and extended time seated can exacerbate existing symptoms of edema. Consider wearing a compression garment for such travel, except if you have open wounds or poor circulation in the affected limb.
- Typically, treating edema begins with diagnosing and treating the underlying cause. Additionally, diuretics may be prescribed to increase water output from the kidneys, and combining these with a low-sodium diet can help to decrease fluid retention. Peripheral edema can also be treated by wearing compression stockings, which apply more pressure to the affected area and can help force fluid to be reabsorbed into the intravascular compartment.