Cardiovascular Discussion Peer Response
Indeed the EKG leads you show will demonstrate depression when read. This is in line with cardiovascular disease or acute coronary syndrome (ACS) that encompasses angina pectoris and myocardial infarction (Jameson et al., 2018; Hammer & McPhee, 2018). According to the American College of Cardiologists or ACC 2017 guidelines, Lorene is in stage II hypertension as per her blood pressure reading (ACC, 2017). I agree with you totally that a major point of difference between the ACC 2017 guidelines and the JNC 8 guidelines is in the use of existing comorbid conditions and chronological age in classifying stages of hypertension. Cardiovascular Discussion Peer Response Essay
The treatment goal as you state is to lower the B to levels that are recommended by each of the guidelines above. For Lorene, the treatment you outline will be applicable except for the thiazide diuretics. Because she is pre-diabetic, thiazide diuretics will be contraindicated as they cause peripheral tissue insulin intolerance (Jameson et al., 2018; Hammer & McPhee, 2018). The remaining ones will apply as stated viz angiotensin receptor blockers (ARBs), angiotensin converting enzyme inhibitors or ACEIs, and calcium channel blockers (ACC, 2017; Rosenthal & Burchum, 2018). I however agree that for genetic reasons, Lorene being African American would not benefit from ACEIs. Giving her this class of medication would violate the ethical principle of nonmaleficence. This means that thiazide diuretics and ACEIs would be excluded in Lorene’s drug regimen even though they are recommended by the guidelines.
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Certainly the primary diagnosis for Lorene is acute coronary syndrome or ACS. You are also right about the secondary diagnosis and indeed it may be hyperlipidemia or the broader metabolic syndrome (Jameson et al., 2018; Hammer & McPhee, 2018). Lastly, after removing the thiazide diuretic and excluding ACEIs, the only other change in the treatment plan would be to lower the dose of the atorvastatin (Lipitor) from 40 mg which is too high to 20 mg orally daily (Rosenthal & Burchum, 2018).
References
American College of Cardiology [ACC] (2017). New ACC/AHA high blood pressure guidelines lower definition of hypertension. https://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017
Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. McGraw-Hill Education.
Jameson, J.L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., & Loscalzo, J. (Eds) (2018). Harrison’s principles of internal medicine, 20th ed. McGraw-Hill Education.
Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. Elsevier.
Cardiovascular Discussion Peer Response Essay