NR603 Week 3 Cardiovascular
Case Study | Advanced Clinical
Diagnosis & Management
Across the Lifespan | Complete
Discussion & Exam Solutions
, 1. What Leads Demonstrate the ST Depression? j j j j j
ST depression is displayed when the ST segment of an electrocardiogram tracing is
j j j j j j j j j j j j j
below the baseline. ST depression can indicate cardiac diseases, an increase in risk
j j j j j j j j j j j j j
for cardiac events, and an increased myocardial ischemia (American College of
j j j j j j j j j j j
Cardiology & American Heart Association, 2019). ST depression can show past j j j j j j j j j j j
myocardial assault as well as acute changes (Mishra et al., 2018). j j j j j j j j j j
Coronary artery disease is indicated when the patient has ST depression in leads j j j j j j j j j j j j j
V4-V6 (Shemirani, 2016). In Lorene’s case, leads I, II, V2, V3, V4, V5, and V6 show ST
j j j j j j j j j j j j j j j j j
depressions. Her EKG in the office show ST expression in multiple leads which j j j j j j j j j j j j j
indicates NSTEMI. j
2. Is Lorene Hypertensive per ACA 2017 Guidelines? Compare the
j j j j j j j j j
ACA guidelines to JNC 8 guidelines and discuss what treatment j j j j j j j j j j
you recommend for her BP and why. j j j j j j
JNC8 guidelines consider hypertension with a blood pressure of 150/90 or higher in a
j j j j j j j j j j j j j j
patient 60 years and older. In a patient 60 or younger, 140/90 is considered hypertension.
j j j j j j j j j j j j j j j
ACA guidelines suggest hypertension is a blood pressure (BP)reading of 140/90 or greater,
j j j j j j j j j j j j j
home blood pressure reading of 135/85 or greater, daytime ambulatory blood pressure
j j j j j j j j j j j j
135/85, nighttime ABPM 120/70. This is based on an average of 2 or more readings on 2 or
j j j j j j j j j j j j j j j j j j
more occasions. Lorene is hypertensive according to both guidelines with an in-office BP
j j j j j j j j j j j j j
reading of 146/90 and a previous diagnosis of hypertension in which she discontinued her
j j j j j j j j j j j j j j
prescribed medication of lisinopril. JNC8 (2014) recommendation is treating the African j j j j j j j j j j j
American population initially with a thiazide diuretic or a calcium channel blocker. The BP
j j j j j j j j j j j j j j
goal is less than 140/90. When looking at the ACA 2017 guidelines on hypertension, Lorene
j j j j j j j j j j j j j j j
would be considered hypertensive. Hypertension has two stages of which stage one is
j j j j j j j j j j j j j
classified as a systolic of 130-139 or a diastolic of 80-89 and stage two is classified as a
j j j j j j j j j j j j j j j j j j
systolic of greater than or equal to 140 or a diastolic greater than or equal to 90. When
j j j j j j j j j j j j j j j j j j
comparing the ACA 2017 guidelines with the JNC-8 guidelines there are many similarities, j j j j j j j j j j j j j
but also several differences. Both have similar ideas on what hypertension is however the
j j j j j j j j j j j j j j
JNC-8 guidelines breaks down the classification of when to treat further depending upon
j j j j j j j j j j j j j
age, race, and other conditions such as diabetes or kidney disease.
j j j j j j j j j j
The ACA 2017 guidelines base their recommendations around the 10 year risk of
j j j j j j j j j j j j j
atherosclerotic cardiovascular disease. Both guidelines consider thiazide diuretics, CCBs j j j j j j j j j
and ACE inhibitors or ARBs as first line treatment for hypertension. The goal blood pressure
j j j j j j j j j j j j j j j
in theACA2017 guidelines for most criteria is 130/80 whereas the JNC- 8 has different goals
j j j j j j j j j j j j j j j j j
dependent upon the comorbidities of the patient. After reviewing both guidelines, there is a j j j j j j j j j j j j j j
common recommendation that in the general black population including those with
j j j j j j j j j j j
diabetes, first line treatment would include a thiazide j j j j j j j
, diuretic and/or a calcium channel blocker. Since the patient has trace edema in
j j j j j j j j j j j j j
bilateral
Case Study | Advanced Clinical
Diagnosis & Management
Across the Lifespan | Complete
Discussion & Exam Solutions
, 1. What Leads Demonstrate the ST Depression? j j j j j
ST depression is displayed when the ST segment of an electrocardiogram tracing is
j j j j j j j j j j j j j
below the baseline. ST depression can indicate cardiac diseases, an increase in risk
j j j j j j j j j j j j j
for cardiac events, and an increased myocardial ischemia (American College of
j j j j j j j j j j j
Cardiology & American Heart Association, 2019). ST depression can show past j j j j j j j j j j j
myocardial assault as well as acute changes (Mishra et al., 2018). j j j j j j j j j j
Coronary artery disease is indicated when the patient has ST depression in leads j j j j j j j j j j j j j
V4-V6 (Shemirani, 2016). In Lorene’s case, leads I, II, V2, V3, V4, V5, and V6 show ST
j j j j j j j j j j j j j j j j j
depressions. Her EKG in the office show ST expression in multiple leads which j j j j j j j j j j j j j
indicates NSTEMI. j
2. Is Lorene Hypertensive per ACA 2017 Guidelines? Compare the
j j j j j j j j j
ACA guidelines to JNC 8 guidelines and discuss what treatment j j j j j j j j j j
you recommend for her BP and why. j j j j j j
JNC8 guidelines consider hypertension with a blood pressure of 150/90 or higher in a
j j j j j j j j j j j j j j
patient 60 years and older. In a patient 60 or younger, 140/90 is considered hypertension.
j j j j j j j j j j j j j j j
ACA guidelines suggest hypertension is a blood pressure (BP)reading of 140/90 or greater,
j j j j j j j j j j j j j
home blood pressure reading of 135/85 or greater, daytime ambulatory blood pressure
j j j j j j j j j j j j
135/85, nighttime ABPM 120/70. This is based on an average of 2 or more readings on 2 or
j j j j j j j j j j j j j j j j j j
more occasions. Lorene is hypertensive according to both guidelines with an in-office BP
j j j j j j j j j j j j j
reading of 146/90 and a previous diagnosis of hypertension in which she discontinued her
j j j j j j j j j j j j j j
prescribed medication of lisinopril. JNC8 (2014) recommendation is treating the African j j j j j j j j j j j
American population initially with a thiazide diuretic or a calcium channel blocker. The BP
j j j j j j j j j j j j j j
goal is less than 140/90. When looking at the ACA 2017 guidelines on hypertension, Lorene
j j j j j j j j j j j j j j j
would be considered hypertensive. Hypertension has two stages of which stage one is
j j j j j j j j j j j j j
classified as a systolic of 130-139 or a diastolic of 80-89 and stage two is classified as a
j j j j j j j j j j j j j j j j j j
systolic of greater than or equal to 140 or a diastolic greater than or equal to 90. When
j j j j j j j j j j j j j j j j j j
comparing the ACA 2017 guidelines with the JNC-8 guidelines there are many similarities, j j j j j j j j j j j j j
but also several differences. Both have similar ideas on what hypertension is however the
j j j j j j j j j j j j j j
JNC-8 guidelines breaks down the classification of when to treat further depending upon
j j j j j j j j j j j j j
age, race, and other conditions such as diabetes or kidney disease.
j j j j j j j j j j
The ACA 2017 guidelines base their recommendations around the 10 year risk of
j j j j j j j j j j j j j
atherosclerotic cardiovascular disease. Both guidelines consider thiazide diuretics, CCBs j j j j j j j j j
and ACE inhibitors or ARBs as first line treatment for hypertension. The goal blood pressure
j j j j j j j j j j j j j j j
in theACA2017 guidelines for most criteria is 130/80 whereas the JNC- 8 has different goals
j j j j j j j j j j j j j j j j j
dependent upon the comorbidities of the patient. After reviewing both guidelines, there is a j j j j j j j j j j j j j j
common recommendation that in the general black population including those with
j j j j j j j j j j j
diabetes, first line treatment would include a thiazide j j j j j j j
, diuretic and/or a calcium channel blocker. Since the patient has trace edema in
j j j j j j j j j j j j j
bilateral
