NR603 Week 3 Case Discussion Cardiovascular

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). 1The 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 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