What Leads Demonstrate the ST Depression?
Lorene demonstrates ST depression dispersed throughout the EKG. Specifically, the
depression is exhibited in leads I, II, V4, V5, a slight depression in aVF, and V6. There is
...
What Leads Demonstrate the ST Depression?
Lorene demonstrates ST depression dispersed throughout the EKG. Specifically, the
depression is exhibited in leads I, II, V4, V5, a slight depression in aVF, and V6. There is
also an ST elevation in aVR. The EKG shows signs of acute coronary syndrome (ACS).
An EKG for ACS will show ST depression in six or more leads, most significant in leads
V4 to V6, particularly when related with inverted T waves and ST elevation in lead aVR.
These EKG changes should warrant importance for urgent, aggressive evaluation
because of the high probability of severe angiographic coronary artery disease.
Is Lorene Hypertensive per ACA 2017 Guidelines? Compare the ACA guidelines to
JNC 8 guidelines and discuss what treatment you recommend for her BP and
why.
According to the American College of Cardiology (ACC), Lorene’s blood pressure, which
is 146/90, would place her in stage II hypertension (HTN). The ACC definitions of stage
II is systolic greater than or equal to 140 or diastolic greater than or equal to 90. Her
blood pressure numbers falls within the guidelines recommendations (Whelton, &
Carey, 2018). The ACA and JNC 8 guidelines report the difference in opinions about the
blood pressure parameters. According to ACA normal blood pressure is systolic less
than 120 mm Hg and diastolic less than 80 mm Hg. HTN stage 1 systolic BP (SBP) is
130-139 mm Hg or diastolic BP (DBP) 80-89 mm Hg, and HTN stage 2 SBP greater
than or equal to 140 mm Hg or DBP greater than or equal to 140 mm Hg or DBP greater
than or equal to 90 mm Hg (Whelton, & Carey, 2018). The JNC 8 recommendation is
high blood pressure goals and to use fewer medications. The guidelines also factor in
the SBP and DBP with age and comorbidity-specific treatment. For example, a patient
who is 60 years old without diabetes (ADA) or chronic kidney disease (CKD), the blood
pressure goal is to be less than 150/90 mm Hg. In younger patients and patients who is
60 with a history of ADA and CKD, the goal for blood pressure is less than 140/90 mm
Hg. The ACA is a stricter guideline, recommending lowering numbers no matter what
comorbidities that patient has (American Family Physician, 2017). After reviewing the
two guidelines, a slower method of controlling blood pressure will be adopted. Lorene is
considered obese. She has hypertension, metabolic Syndrome, and dyslipidemia. She
also had a history of gestational diabetes, and her current A1c is elevated at 6.4%. With
her current ST changes, Lorene’s blood pressure will need to be lowered. However,
starting aggressive treatment is not ideal, and she may feel the effects of lowering her
BP to quickly. Lorene needs to go back on medications. However, her belief about
controlling her BP with diet and exercise is correct and will be adopted in her treatment
plan mentioned later in this case study response.
What is the Primary diagnosis causing Lorene's chest pain? Include ICD
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