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Cardiac Case Discussion
Week 3 Discussion Questions:
1. What Leads Demonstrate the ST Depression?
ST depression is indicative of acute myocardial ischema and hypoxia. Heart failure may
cause ST depression and this is seen in leads V2, V3, V4, V5, and V6 (Klabunde, 2016;
Harhash et al 2017). These depressions are horizontal or downsloping.
2. 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.
Lorene’s blood pressure is 146/90, she is a 60 year old African American female with a
history of hypertension, dyslipidemia, gestational diabetes x 3, and metabolic syndrome. Yes
Lorene is hypertensive based on the ACC/AHA guidelines since her BP is greater than 130/80
and she has a high cardiovascular disease risk (Mutner et al, 2017).
Compared with the JNC 8 guideline, the 2017 ACC/AHA guideline recommends using
lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels to define
hypertension which means systolic less than 130 mm Hg and diastolic less than 80 mm Hg
(Mutner et al, 2017). The JNC 8 guidelines establish treatment for persons aged 60 years
and older with a BP goal of less than 150/90 mm Hg (James et al, 2014). For persons 30
years through 59 years old should maintain a diastolic goal of less than 90 mm Hg and a
goal of
140/90 mm Hg based on their physcian’s expert opinion (James et al, 2014).
The 2017 ACC/AHA guidelines recommend combination therapy for all patients in stage
2 hypertension like Lorene. A recent study in Hypertension (Jaejin et al, 2021) found that a
, 2
higher percentage of patients on combination therapy including an ACEI-thiazide diuretic
compared with patients on monotherapy reached their blood pressure goals and achieved
BP control. Participants on combination ACEI-thiazide diuretics also had better medication
adherence, reduced treatment inertia, and lower cardiovascular events compared to
monotherapy participants. Lorene will start combination therapy to meet the ACC/AHA
guidelines with one generic combination pill Lisinopril/hydrochlorothiazide 12.5 mg/10 mg
to start and continue diet and exercise.
3. What is the Primary diagnosis causing Lorene's chest pain? Include ICD 10 codes (no
differentials)
Angina pectoris, unspecified (ICD-10 code I20.9)- Disease can be diagnosed based on an
ECG, clinical exam, or cardiac imaging (Thadani, 2016).
4. What other secondary diagnoses does Lorene have that should be addressed? (Include the
rationale and a reference for your diagnoses)
• Hypertension (ICD-10 code I10)- Lorene’s BP is 146/90 and pulse is 70 and she has an
increased risk of CVD along with lower extremity edema so she meets both guidelines by
the ACC/AHA and JNC 8. All adults recommended by the JNC 8 for hypertensive
medication is also recommended by the ACC/AHA guidelines and considered to have
hypertension. Adults with a high CVD risk or 65 years old and older with SBP of 130139
mm Hg or DBP of 80-89 mm Hg are recommended for taking antihypertensive
medication (Muntner et al, 2018). The ACC/AHA guideline is treating SBP/DBP to a goal
of <130/80 mm Hg (Munter et al, 2018)
• Hyperlipidemia, unspecified (ICD-10 code E78.5)- Lorene’s total cholesterol is 230 mg/dL
(120-240 mg/dL normal range), triglycerides 180 mg/dL (0-200 mg/dL normal), LDL 180
mg/dL (62-130 mg/dL normal), and HDL 38 mg/dL (35-135 mg/dL normal). Total
Cardiac Case Discussion
Week 3 Discussion Questions:
1. What Leads Demonstrate the ST Depression?
ST depression is indicative of acute myocardial ischema and hypoxia. Heart failure may
cause ST depression and this is seen in leads V2, V3, V4, V5, and V6 (Klabunde, 2016;
Harhash et al 2017). These depressions are horizontal or downsloping.
2. 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.
Lorene’s blood pressure is 146/90, she is a 60 year old African American female with a
history of hypertension, dyslipidemia, gestational diabetes x 3, and metabolic syndrome. Yes
Lorene is hypertensive based on the ACC/AHA guidelines since her BP is greater than 130/80
and she has a high cardiovascular disease risk (Mutner et al, 2017).
Compared with the JNC 8 guideline, the 2017 ACC/AHA guideline recommends using
lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels to define
hypertension which means systolic less than 130 mm Hg and diastolic less than 80 mm Hg
(Mutner et al, 2017). The JNC 8 guidelines establish treatment for persons aged 60 years
and older with a BP goal of less than 150/90 mm Hg (James et al, 2014). For persons 30
years through 59 years old should maintain a diastolic goal of less than 90 mm Hg and a
goal of
140/90 mm Hg based on their physcian’s expert opinion (James et al, 2014).
The 2017 ACC/AHA guidelines recommend combination therapy for all patients in stage
2 hypertension like Lorene. A recent study in Hypertension (Jaejin et al, 2021) found that a
, 2
higher percentage of patients on combination therapy including an ACEI-thiazide diuretic
compared with patients on monotherapy reached their blood pressure goals and achieved
BP control. Participants on combination ACEI-thiazide diuretics also had better medication
adherence, reduced treatment inertia, and lower cardiovascular events compared to
monotherapy participants. Lorene will start combination therapy to meet the ACC/AHA
guidelines with one generic combination pill Lisinopril/hydrochlorothiazide 12.5 mg/10 mg
to start and continue diet and exercise.
3. What is the Primary diagnosis causing Lorene's chest pain? Include ICD 10 codes (no
differentials)
Angina pectoris, unspecified (ICD-10 code I20.9)- Disease can be diagnosed based on an
ECG, clinical exam, or cardiac imaging (Thadani, 2016).
4. What other secondary diagnoses does Lorene have that should be addressed? (Include the
rationale and a reference for your diagnoses)
• Hypertension (ICD-10 code I10)- Lorene’s BP is 146/90 and pulse is 70 and she has an
increased risk of CVD along with lower extremity edema so she meets both guidelines by
the ACC/AHA and JNC 8. All adults recommended by the JNC 8 for hypertensive
medication is also recommended by the ACC/AHA guidelines and considered to have
hypertension. Adults with a high CVD risk or 65 years old and older with SBP of 130139
mm Hg or DBP of 80-89 mm Hg are recommended for taking antihypertensive
medication (Muntner et al, 2018). The ACC/AHA guideline is treating SBP/DBP to a goal
of <130/80 mm Hg (Munter et al, 2018)
• Hyperlipidemia, unspecified (ICD-10 code E78.5)- Lorene’s total cholesterol is 230 mg/dL
(120-240 mg/dL normal range), triglycerides 180 mg/dL (0-200 mg/dL normal), LDL 180
mg/dL (62-130 mg/dL normal), and HDL 38 mg/dL (35-135 mg/dL normal). Total
