Clients with syncope or aborted sudden death
thought to have been due to temporary factors
(acute MI, bradyarrhythmias subsequently treated
with permanent pacing, drug effect, electrolyte
imbalance) should be strongly advised after recovery
not to drive for at least 1 month. Other clients, lik...
Harry comes to your office with waxing and waning ischemic symptoms over a
period of days and weeks, an increase in angina while at rest and transient ST
changes on his electrocardiogram. This presentation leads you to believe that he
is experiencing:
A. a stroke.
B. a myocardial infarction.
C. stable angina.
D. unstable angina.
✓~ Unstable Angina
Answer D
The clinical presentation of unstable angina may
include waxing and waning of ischemic symptoms
,over a period of days or weeks. It often involves
a progressive increase in symptoms in those with
previous stable angina, including rest angina,
and may include transient ST changes on the
electrocardiogram. The differential diagnosis of
unstable angina versus ST-segment elevation
myocardial infarction (STEMI) versus non-
STEMI is confirmed by the elevation of serum
troponin. Important to note is the possibility of
acute coronary syndrome without the alteration in
electrocardiographic display.
A newly discharged outpatient surgery client presents with insidious onset of
edema and dusky blue discoloration of the head and upper extremities. You know
it is a medical emergency and suspect which of the following?
A. Evolving cerebral infarction
,B. Impending myocardial infarction
C. Superior vena cava syndrome
D. Temporal arteritis
✓~ Superior Vena Cava Syndrome
Answer C
Superior vena cava syndrome occurs when there
is obstructed venous return from the upper
extremities, head, and neck region. Symptoms
include edema and dusky blue discoloration of
the upper extremities and head. Both the location
of the obstruction and the rapidity with which it
develops will determine the severity of symptoms.
Diagnostic studies include chest radiography, CT,
and venography. A CT scan is the most widely
used. The most common cause of superior vena
cava syndrome is cancer. Primary or metastatic
, cancer in the upper lobe of the right lung can
compress the superior vena cava. Lymphoma or
other tumors located in the mediastinum can
also cause compression of the superior vena cava.
Less often, the superior vena cava can become
blocked with a blood clot from within. As more
invasive medical procedures are being performed
on clients, this cause of superior vena cava
syndrome is being seen more frequently. Blood clot
(thrombus) formation that causes superior vena
cava syndrome is a complication of pacemaker
wires, dialysis, and other intravenous catheters
that are threaded into the superior vena cava
(SVC). Signs and symptoms of SVC Syndrome
may include shortness of breath and swelling of the
arms and face. The symptoms occur because blood
cannot return to the heart. Management of SVC
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