Right ventricular infarction: a clinical case study

Article Abstract:

Right ventricular infarction (RVI) is a heart attack that involves the right ventricle of the heart, which is the pumping chamber responsible for delivering blood to the lungs for oxygenation. The condition was discovered in the 1930s and has only been clinically diagnosable since 1974. It is often associated with left ventricular inferior wall infarction, with a recent autopsy study showing RVIs occurring in 24 percent of these heart attacks. Normal electrocardiogram (ECG) techniques often fail to detect RVI because the right ventricle is often obscured by the left ventricle. It is important that RVIs be detected because treatment is different from that of heart attacks only involving the left ventricle. The case is reported of a 63-year-old woman with RVI to point out characteristics of the disease and how to improve nursing treatment of it. The patient had hypertension (high blood pressure) and diabetes, and smoked. Initial ECG led to a diagnosis of acute inferior wall myocardial infarction. She underwent cardiac catheterization, which revealed occlusion of the right coronary artery. Complete heart block occurred during this procedure and RVI was diagnosed because of systemic hypotension (low blood pressure). RVIs increase the stiffness of the right ventricle, which impedes diastolic filling and elevates systemic pressure in the veins in response to systemic hypotension. The patient's lungs remained clear, as is a usually true with RVI. Other clinical findings often found with RVIs include elevations in the ST segment of the ECG, advanced atrioventricular nodal (AV) blocks and increased pressure in the right atrium and ventricle. The hypotension associated with RVIs can be treated by increasing blood volume with intravenous fluids. Diuretics, which cause a loss of fluids from the body, should be avoided. Drugs that increase left ventricular emptying can help increase passive filling to make up for the impaired right ventricle, and are needed, as in this patient, when AV blocks occur. Awareness of the symptoms of RVI can lead to early, appropriate treatment and increase the chances of a positive outcome for the patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Case studies, Physiological aspects, Heart attack, Infarction, Heart ventricle, Right, Right heart ventricle

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Effects of support groups on anxiety of family members during critical illness

Article Abstract:

The critical illness of a family member is a serious event that often disturbs the family's equilibrium and provokes family crisis. The family often feels unprepared to deal with such an event and feels fear, shock, resentfulness, disbelief, and often withdraws from contacts with friends. At this time, the family needs support, especially in situations where the disease is severe and long-term in nature. Nurses who care for such patients have a unique opportunity to help support the family that is attempting to cope with the patient's disease. A recent study examined the effectiveness of support groups in decreasing the family's anxiety about the patient's disease. One group of 30 families received bedside support from nurses, physicians, or other types of health professionals. The other group of 25 families attended a support group to talk about their experiences and feelings. No significant difference was found in the amount of anxiety between families who went to support groups and families receiving support from nurses. Both groups had a lower amount of anxiety after receiving support than before receiving support. Family members with high anxiety tended to stay in the hospital with the patient more than family members with low anxiety. It is suggested that the families of patients with a critical illness receive support to help them cope with the patient's condition. Support can be obtained either from a group setting or from health professionals such as nurses. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Social aspects, Evaluation, Social networks, Patients, Interpersonal relations, Catastrophic illness, Long-term care of the sick, Long term care

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