Answer to the question

Describe the difference between the items in each question.

1. What is the difference between a thrombus and an embolus?
2. What is the difference between primary and secondary hypertension?
3. What is the difference between myocardial hibernation and myocardial stunning?
4. What is the difference between dilated and restrictive cardiomyopathy?
5. What is the difference between valvular stenosis and valvular regurgitation?

Write your response to each situation in the space provided.

78. “Stress si al ni your head! exclaims M.r Weis. I” do not want to take that stress manage- ment class! How can stress afect blood pressure?”

79. Mr. Evers has a newly diagnosed aortic aneurysm. “What is an aneurysm?” says his part- ner. “And why do they want to operate to fix it? He feels fine!”

80. Mrs. Gao developed a deep venous thrombosis during a long car ride. “Tell me again those three big causes of leg clots,” she says. “I want to avoid all of them in the future!”

81. “My uncle had a heart attack, and my father had a stroke,” says Mr. Carradine. “My doctor said they were caused by the same thing, but I do not see how. Can you explain?”

82. “Why do I get so tired and faint when I try to exercise?” says M.r Azul, who has mild aortic stenosis. “I am fine when Iam not exercising.”

83. “I heard the doctor tell the medical student that heart failure with reduced ejection frac- tion and heart failure with preserved ejection fraction are two kinds of heart failure,” says Mr. Moon. “My doctor said I have heart failure with reduced ejection fraction, but I do not know what that means. Please explain.”

84. Mr. Santos has left ventricular hypertrophy from hypertension. “How does that increase my risk of heart attack?” he asks. “I think big strong muscles are a good thing!”

85. “My husband is in the emergency department, and they said he has acute coronary syn- drome!” exclaims Mrs. Gato. “Is that a heart attack?”

86. Mrs. Fewe was diagnosed with atrial fibrillation. “Oh, no! Grandma is dying! Cal 911!” shouts Kendra, age 1, when she hears the diagnosis. “Fibrillation si an emergency!”

Clinical scenarios

Read the clinical scenarios and answer the questions to explore your understanding of cardiac pathophysiology.

Mr. Kent, a 57-year-old nurse, developed crushing substernal chest pain with dyspnea, dizziness, and nausea while trying to lift a patient from a bed to a chair. In the emergency department, he states that his symptoms resolved as soon as he sat down to rest. Mr. Kent indicates that he has had similar episodes in the past, particularly when trying to do strenuous yard work. After an ECG and other tests, his diagnosis is stable angina.

Done

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1. What assessment questions should you ask Mr. Kent about his risk factors for coronary heart disease?
2. Why is it important to examine the appearance of Mr. Kent’s lower extremities and palpate his pedal pulses?
3. Now that Mr. Kent’s chest pain is completely resolved, what might his electrocardiogram show?
4. ”I work pediatrics, not with adults,” says Mr. Kent. “Remind me what stable angina is. It has been a long time since nursing school.”
5. Mr. Kent says, “I seem to remember that some people have angina pain that is not in the chest. Is that correct?”

72 Treasing leake upcall fl in em. ye that wilt to take eter care of mysel. Tell

Mr. Williamson, age 81, had been feeling tired for several weeks. When he developed extreme shortness of breath, his wife took him to the emergency department. The emergency department personnel listened to his lungs, took a radiograph, and gave him an intravenous diuretic. He was admitted to the hospital with pulmonary edema from acute biventricular heart failure. After a few days, he was discharged from the hospital with various medications and instructions to modify his diet and weigh himself every morning.

1. What fluid imbalance did Mr. Williamson have when he was taken to the emergency de-partment? What parts of the clinical scenario provide the evidence for your answer?
2. What did the emergency department personnel hear when they listened to Mr. William-son’s lungs?
3. When Mr. Williamson was admitted to the hospital, what did assessment of his ankles most likely reveal? Why?
4. When Mr. Williamson was admitted to the hospital, what was the most likely character of his pulse?
5. Why was Mr. Williamson instructed to weigh himself every morning?