Transcript: Severe COPD vs COPD exacerbation Acute respiratory insufficiency / distress Acute respiratory failure Chronic respiratory failure Acute on chronic respiratory failure COPD 93 yo female presented to HTH with chest pain and was transferred to SMH with a possible STEMI. DIAGNOSES #1 ACS with LV dysfunction of the anterior and apical wall #2 Acute moderate pulmonary edema After clarification: #1 Non-ST-segment elevation myocardial infarction #2 Congestive heart failure, resolved, secondary to atrial fibrillation and non-ST-segment elevation myocardial infarction “Acute systolic heart failure” Acute Coronary Syndrome FINAL PRIMARY DIAGNOSIS #1 Acute on chronic heart failure, diastolic, Left and Right sided. ADDITIONAL DIAGNOSES #1 Acute on chronic respiratory distress #2 Bilateral pulmonary edema #3 Hyperlipidemia #4 Hypertension #5 Acute renal failure, possibly acute on chronic Acute Renal Failure with Acute tubular necrosis #6 Controlled Diabetes Mellitus, Type 2 with peripheral neuropathy and retinopathy #7 Paroxysmal atrial fibrillation, no RVR, anticoagulated #8 Obesity, BMI 37 Summary Diagnoses #1 Paroxysmal atrial fibrillation with rapid ventricular response #2 Acute on chronic left ventricular diastolic heart failure secondary to cardiac amyloidosis #3 Cardiac amyloidosis #4 Chronic pericardial effusion #5 Cough #6 Right lower lobe pulmonary infiltrate We will continue a Levaquin antibiotic therapy initiated on January 7 for a total length of five days to cover possible community-acquired pneumonia. #7 Chronic kidney disease stage 3 #8 Gout Cardiology Documentation Improvement Chief Complaint Dyspnea, shortness of breath History of Present Illness Mrs. Doe is an 85 yo woman who has had significant SOB and hypoxemia for the past year. History of diastolic heart failure and chronic COPD. She is currently on 3 L oxygen all day due to hypoxemia. She was seen in heart failure clinic today and was admitted for IV diuresis. O2 sat at 86% on RA at rest. Fatigue with noticeable exacerbation from baseline dyspnea. BMI 47 kg/m2 Unstable Angina NSTEMI - date STEMI - name wall location & date Acute Coronary Syndrome CHRONIC OBSTRUCTIVE PULMONARY DISEASE (C O P D) Severity / Acuity Documentation Document all diagnosis to the highest specificity Document all medical conditions that are monitored, evaluated, or treated "Hypokalemia" "Hyponatremia" "Pancytopenia" Document the cause or probable cause of a symptom as specific as possible. "Acute blood loss anemia related to GI bleed" Document any diagnosis confirmed by lab tests, radiology exams, pathology reports. Use ACUTE instead of extreme or severe "Acute Endocarditis" "Acute Pulmonary Embolism" "Acute Myocardial Infarction, type, vessel, date of MI" FINAL PRIMARY DIAGNOSIS #1 Unstable angina due to ....... (link cause) ADDITIONAL DIAGNOSES #2 Coronary artery disease, LAD predominance #3 History of dilated cardiomyopathy, possibly secondary to chronic alcohol abuse "Alcoholic Cardiomyopathy" #4 Transfusion dependent iron deficiency anemia #5 Pancytopenia #6 Tobacco dependence #7 Medication noncompliance #8 Malnutrition, BMI 17.5 Acute / Chronic Respiratory Failure Summary Diagnoses Excellent Documentation FINAL PRIMARY DIAGNOSIS #1 Acute on chronic left diastolic heart failure ADDITIONAL DIAGNOSES #2 Acute on chronic respiratory failure #3 COPD exacerbation #4 Uncontrolled hypertension #5 Paroxysmal atrial fibrillation #6 Hypokalemia, chronic, likely due to Lasix use #7 Acute kidney injury, pre-renal due to diuresis #8 Diabetes Type 2, uncontrolled #9 Morbid Obesity, BMI 47 kg/m2 Final Take Away Message Avoid Documenting ACS when indicating MI Document severity of COPD Exacerbation Respiratory failure / Insufficiency Acute / Chronic Link symptoms to cause Capturing Severity and Risk of Mortality Acute Coronary Syndrome Clarification Summary Diagnoses Good Example Cardiology Admission Note IMPRESSION/REPORT/PLAN (resident) #1 Likely non-ST-segment elevation MI #2 Systolic heart failure, Ejection fraction of 17% Consultant’s note: ( x 3days) #1 Possible acute coronary syndrome with positive troponin At this point, we will treat her as an acute coronary syndrome and continue to follow her on monitor and with cardiac biomarkers. After clarification: #1 Non-ST-segment elevation myocardial infarction #2 Compensated biventricular systolic heart failure Ms. XXX ultimately ruled in for non-ST-segment elevation myocardial infarction Sharon Axtman, RN Cristina Rosero de Ruales, RN Acute Coronary Syndrome
Transcript: Cardiology What is it? Cardiology is a medical specialty dealing with disorders of the heart. Terms Artery A vessel that carries blood away from the heart. Aortic Relating to the aorta, which is the major vessel that carries oxygenated blood from the heart to the body Atrium The chamber of the heart that collects blood returning from the rest of the body Vein A vessel that carries blood towards the heart Ventricle The chamber of the heart that is responsible for pumping blood out to the rest of the body. How much schooling It takes about 12 years for all of your schooling, including postgraduate school and medical school. How much does a cardiologist get paid? A cardiologist gets paid $400,000 a year. Where is a school that offers this program? Yale University and the University of Iowa What kind of courses do you need to get into Cardiology? physics : a natural science dealing with matter and it's motion. Biology : A natural science of the study of life and living organisms. Mathematics : The study of quantity, space, structure, and change. English : The structure of words, phrases, clauses, and sentences. Chemistry : The science of matter, it's properties, structure, composistion, behavior, reactions, and change. Inorganic Chemistry : The branch of chemistry dealing with the behavior of inorganic compounds. Organic Chemistry : The branch of chemistry dealing with the study of carbon-based compounds. Associated Jobs Cardiovascular Surgeon - A cardiac surgeon is a surgeon who performs operative procedures on the heart and great vessels. Cardiovascular Technician - Assist physicians in diagnosing and treating cardiac ailments. Thanks for watching! :) ! Kailey Fleming More Terms A Presentation
Transcript: Cardiology 11- 16- 2018 Case report HINT! INTRO TODAY'S SCHEDULE Ventricular Tachycardia 1. Basic Pathology 2. Risk factors & Symptoms 3. Diagnosis & Treatment 4. Case What? The Pathology Ventricular Arrhythmia Ventricular Arrythmia Types Types of VT Non-Reentrant VT * Ventricular pmc fire at higher rate, prevent SA node from firing ---> ventricular beats drive the HR * Due to: - Drugs (Amphetamine, cocaine etc) - Electrolyte imbalance - Myocardial ischemia in ventricle Reentrant VT (more common type) * Dead cells in myocardial tissue ---> Scar formation --> conduction signals go around scar --> Reentry Risk factors & signs Why? Risk & Symptoms Risk factors * Age * Cardiac disease (eg CMP, VD, post mi) * Electrolyte imbalance (Hyperkalemia) * Drugs (Cocaine) * Pericardial inflammation Symptoms * Chest pain * Shortness of breath * Dizziness * Syncope * Low BP Diagnosis * Serum electrolytes - K+ - Ca++ - Mg+ * ECG - Rate: >100 bpm - P-waves: Absent or Present- - T-waves: Large - QRS complex: Wide (>0,12 s) Diagnosis Treatment TREATMENT MEDICATION * Beta-blockers * Amiodarone * NDHP Ca++ ch. Blockers OTHER * Cardioversion * ICD Who? CASE Anamnesis: * Age: 51 * Sex: Female * Wide QRS * EF 35% --> 45% after medication * Hypokinetik inf. lat. & apical wall * Left ventricular edv 85 ml, 41mm * left ventricular systolic volume 47, 32mm * No pericardial fluid * MRI found scar Lab results * Troponin: Negative * Hc: Elevated * RBC: Elevated * WBC: Elevated * ALP: Elevated * Uric Acid: Elevated * K+: Slightly elevated
Transcript: What is a Cardiologist? -Focus on continuing care of patients. What does a day in a life of a cardiologist look like? First, they walk in their office. Then, they see their first patient of the day. After they meet their first patient, they ask about symptoms that the patient is exhibiting. Once the symptoms are known, the doctor starts to diagnose the patient by thinking how the symptoms relate to a disease. If needed, medical tests such as an echocardiogram or an angiogram are done in order to diagnose the patient. When the doctor arrives at a diagnosis, they tell the patient what it is and how to treat it. The doctor then advises the patient which treatment to take. Treatments include the usage of medication, a change in lifestyle, or even a medical procedure. The doctor will do this for about 4 or 5 more patients. The doctor might even take part in a procedure such as a radiofrequency ablation. First, the person completes undergraduate school (4 years) with an emphasis on science-related classes. Then, the pre-med student goes through medical school for four years. Then the doctor goes through a fellowship (2 years) with cardiologists to know the specifics of the field. Then the student becomes the cardiologist. What colleges offer these programs? Many colleges offer undergraduate programs in science, and even some offer pre-medicine programs. There also exist many medical schools in the United States, as well as the world. Once completing medical school, the medical school arrange a residency for you. A residency is completed at the hospital that the medical school chose for you. A cardiology fellowship is offered at many hopsitals. A radiofrequency ablation is used to treat SVT (Superventricular Tacchychardia) The success rate of a radiofrequency is over 90 percent. I personally have had this procedure, and I had no complications from it. Current Research being done in Cardiology... Dysfunctions in the diabetic heart. Risk factors for heart disease. The effects of kidney disease on the heart. or non-invasive (echocardiographies) A cardiologist normally sees patients with heart issues. "Radiofrequency Ablation". American Heart Association. 8.29.10 <http://www.strokeassociation.com/presenter.jhtml?identifier=4682>. Salamon, Maureen. "Do I Need to See a Cardiologist?". about.com. 8.29.10 <http://heartdisease.about.com/lw/Health-Medicine/Conditions-and-diseases/Do-I-Need-to-See-a-Cardiologist-.htm>. Cardiology is the field of medicine that studies and treats the heart. - A Cardiologist is a doctor that deals with heart problems. Then the post-medical student goes through a residency (3 years) at a hospital. What is the success rate of a radiofrequency ablation? -They also insert permanent and temporary cardiac pacemakers Cardiology Tim Klincewicz What kind of patients does a cardiologist see? Works Cited tests in order to diagnose patients. A normal cardiologist does not see patients under 18 years old. "Cardiologist". Schoolsintheusa.com. 8.29.10 <http://www.schoolsintheusa.com/careerprofiles_details.cfm?carid=508>. How many years of schooling does a Cardiologist need? What is Cardiology? Cardiology is the field of science that studies the heart and its associated functions. Cardiology is the field of science that studies the heart and its associated structures. Patients may range from deathly sick to not showing symptoms. "Cardiologist: Job Duties". degreedirectory.org. 8.29.10 <http://degreedirectory.org/articles/Cardiologist_Job_Duties_Occupational_Outlook_and_Education_Prerequisites.html>. -They use invasive (angiographies),
Transcript: Pay attention there is a test at the end! Cardiologist Veins and Arteries Type of Blood it Carries Type of Blood it Carries Veins and Arteries Veins Arteries Veins transport blood towards the heart. Arteries transport blood away from the heart. Oxygen-poor blood Oxygen-rich blood Is Blood Really Blue? Is Blood Really Blue? No, it always has oxygen! Diagram Diagram arteries=red oxygen away from the heart veins=blue oxygen to the heart The Big Four The Big Four Your heart has four chambers your left and right ventricles and artia. Atrium Atrium The atrium recieves blood and pumps it to the ventricles below. Ventricle Ventricle The ventricles push the processed blood into the artiries that supply the rest of the body with blood.
Transcript: Cardiology Cardiology is the study of the heart and cardiologists study the heart. In the heart, the red color is used for blood and oxygen. The red part of the heart is used to pump blood into your arteries. 6. 4. 3. The blue part is used to pump carbon dioxide into your lungs to exchange for oxygen. 9. 2. 1. 8. The other color, blue, is carbon dioxide. 7. 5.
Transcript: You will need to go to a undergraduate college and get bachelor degree ( helium.com 5-2-12). A cardiologist is a medical heart sergeant (boardcertified.com 5-1-12). You have to go to 10 years of college cardiologist get very nervous when the preform sergury because if they mess up they are liable to be sewed Cardiologist are highly trained doctors that give medical treatment on the human hearts (helium.com 5-2-12). "THE PATH OF BECOMING A CARDIOLOGIST IS NOT EASY YOU HAVE MANY YEARS OF TRAINING AND SCHOOLING (HELIUM 5-2-12). A cardiologist By Tanner Keener Cardiology BECOMING A CARDIOLOGIST Procedures that cardiologist preform They also have to preform procedures like heart cauterizations and balloon angioplasty. Worked cited The path of becoming a cardiologist Cardilogist Cardiologist are not only focused on just the heart they focus on the whole cardiovascular system www.boardcertified.com www.huliem.com www.cardiologist.com cardiologist Becoming a cardiologist requires extensive training and supervised experience (board certified.com 5-1-12). Becoming a cardiologist Procedures that cardiologist preform What are cardiologists Some of the most common test preformed by cardiologist (boardcertified.com).
Transcript: By: Breanna DeCaro A doctor who specializes in preventing and treating Cardiologists need a bachelor's degree in order to get into medical school include the following: entering a residency program (3 years) 2 years of specialized cardiology training treating heart conditions and disorders of the heart and cardiovascular system highly qualified cardiologists perform life saving operations some are even able to perform complete heart transplants Traits Needed: Able to handle stress Able to prioritize their problems Expert knowledge of internal medicine Need good motor skills Salary Cardiologists make about 400,000 a year and diagnosing diseases in the heart and blood vessels Responsibilties: A master's would also be helpful Training cardiologists need after medical school Some courses to get a pre- med bachelor degree Requirements Cardiology chemistry mathematics engineering psychology
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