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Cardiovascular Subjective Data:

-        What cannot be precisely measured (Vitals, blood test results => Objective Data)
-        Any data that is not directly from the nurse/healthcare professionals  => Objective Data

-        Primary Source => Patient

-        Secondary Source => Caregivers, other members of the healthcare team

Examples of Subjective Data:

1.     Pain Scale

2.     Colour (From the patient)

3.     Feel (From the patient)

4.     Description of reported symptoms (E.g. chills, diarrhoea, coughing, dizziness, SOB)

5.     Patient's perceptions, feelings, and concerns

Why is Subjective Data important?

-        This data can paint a more thorough picture of what the patient is experiencing, making it an essential part of care plan development

-        May signal possible issues with the patient’s psychological, physiological, and sociological wellness

-        It alerts nurses about things that can be problematic when dealing with patients as well as indicating specific patient’s strengths that can be useful when communicating and caring for them

Mr Lee’s Subjective Data:

·      Patient’s complaints (Primary Source)

-        Crushing chest pain

-        Radiation of pain to jaw and left upper arm

-        Dyspnoea upon exertion for the last two months

-        Claims that he is unable to walk home from the bus stop without feeling breathless

-        Needs to sleep with two pillows under the head

·      Daughter (Secondary Source)

-        Non-compliant with medication

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Objective data in nursing refers to information that can be measured through physical examination, observation, or diagnostic testing (ECG, MRI, X-ray).
- describe by the clinician

Mr Lee's data:
O2 sat: 90% (low)
Blood pressure: 130/99 mmHg (high)
RR: 26 breaths/minute (high)
HR: 100 beats/minute
Temperature: 37.5 degrees
Skin color: pale and diaphoretic; cyanotic lips and extremities
Texture: cold
Heart sounds: -
Lung sounds: crackles (bilateral bases)

Discharge plans and medications

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An ST-elevation myocardial infarction (STEMI) is a type of heart attack that is more serious and has a greater risk of serious complications and death. It gets its name from how it mainly affects the heart's lower chambers and changes how electrical current travels through them.

According to Mr Lee' ECG, he has STEMI as there is more than 1-2mm of ST elevation in two contiguous leads.

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Heart failure (definition)

Condition in which the heart is unable to pump blood at a rate that is consistent w requirements of the body

Acute Vs Chronic: For chronic, it is a sudden or gradual decrease in CO respectively & associated with edema

Left vs Right Heart failure

RHF: Defective pulmonary flow and systemic congestion

LHF: Defective systemic flow and pulmonary congestion

Common causes include:

decreased cardiac function (IHD, AMI, valvular heart disease, cardiomyopathy)

Increased workload (hypertension, pericarditis etc)

Diagnosis of Mr Lee: Chronic Left heart failure

Pt has shortness of breath (difficulty breathing)

LHF results in decreased cardiac output to the body ; blood backup into left atrium and lungs which leads to pulmonary edema. This could affect pt's breathing.

2 pillow orthopnea (orthopnea relieved by placing 2 pillows under his head)

Central and peripheral cyanosis

Crackles heard indicate fluid in lungs (pulmonary edema)

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Define CAD:
Coronary Artery Disease (CAD) is when the occlusion of arteries deprives cardiac muscle of oxygen and nutrients, hence affecting pumping ability of the heart.

Signs and symptoms:
- Chest pain or discomfort (angina)
- Weakness, light headedness, nausea, cold sweat
- Pain or discomfort in the arms or shoulder
- Shortness of breath

Does Mr Lee have CAD?
Yes, he has (1) crushing chest pain, (2) radiation of pain to jaw and left upper arm, (3) experiences increasing dyspnea (shortness of breath) on exertion

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Modifiable risk factors:
Smoking
hypertension
hyperlipidaemia
poor diet: diet high in cholesterol and fats leading to hyperlipidaemia
obesity: excess weight can lead to fatty build up in arteries
diabetes
sedentary lifestyle: causes CAD because lack of exercise results in higher risk of atherosclerosis

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Diagnostic tests: Red - Mr Lee’s, green - normal range

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-it is released when heart muscles are damaged to see if the heart muscles are necrosed
-the more damage to the heart, the more troponin I is released
-in stable/ unstable angina, troponin levels are not increased

Troponin
- enzymes that exist as normal proteins important to the contractile apparatus of the cardiac myocyte
- The proteins are released into the circulation between 3 and 4 hours after myocardial infarction and remain detectable for 10 days following

CK (and CK-MB)
- muscle enzyme that exists as isoenzymes. The MB type is specific to myocardial cells
- CK values are indicative of all CK enzyme levels (MM and BB not shown)

- using such findings, we suspect that Mr Lee has AMI (unable to tell if STEMI/ NSTEMI --> only can tell from
ECG)

https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/cardiac-enzymes