Early recognition of critical stenosis high in the left anterior descending coronary artery
Electrocardiography is a diagnostic tool that involves the production of graphs from electric currents originating in the heart. These electric currents help in the diagnosis of various heart conditions, including heart attacks and abnormal beating patterns. During and after a heart attack, one segment of the electrocardiogram (ECG), the S-T segment, is frequently changed, which is a major indication that a heart attack has occurred. A recent report described the use of electrocardiography in diagnosing the narrowing (stenosis) of one of the major vessels that supplies blood to the heart called the left anterior descending coronary artery. Stenosis of this vessel decreases the amount of oxygen to the heart and often leads to a heart attack. Patients at risk for developing stenosis of this vessel have a history of chest pain, and normal or slightly elevated cardiac enzyme levels. Cardiac enzymes are proteins that are released by the heart into the blood when heart muscle tissue has been injured, as in a heart attack. The patient may have no changes in the S-T segment of the ECG, but may have symmetric T waves. These ECG findings indicate the patient has a decrease in blood flow to the most interior part of the heart muscle, a condition that may affect the entire heart muscle if it is not treated. A recent report describes the case of a 58-year-old man, with no history of heart disease, who developed a chest pain that went away after the patient rested. The next day he suffered severe chest pain and was admitted to the hospital for evaluation. When the pain recurred at night, a nurse performed an ECG that indicated a narrowing of the coronary vessels, which was subsequently confirmed by coronary angiography, a procedure that allows visualization of the heart's blood vessels. Critical care nurses play an important role in the early recognition of disease, and must use their judgement in determining the importance of symptoms when a physician is not available. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Heart and Lung
Alternative medicine in our future
Physician assistants should become more involved in providing alternative therapies. In Washington state, for example, health insurance plans must cover alternative providers who meet state health care service standards. Both health insurers and traditional medical personnel are resistant to alternative medicine and treatments such as massage therapy, acupuncture, and naturopathy. Similarly, the public has come to expect immediate results from conventional medicine and may feel uncomfortable with other techniques.
Publication Name: Physician Assistant
Integrative medicine: taking the plunge
Physician assistants (PAs) should become interested in the growing area of alternative and integrative medicine. PAs can use alternatives therapies while working within a conventional clinical care situation. For example, Trager bodywork techniques can be useful in treating Parkinson's disease. However, traditionally-trained physicians will resist alternative therapies and must be educated as to their value.
Publication Name: Physician Assistant
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