MI (heart attack) _ Angina -

SIGNS & SYMPTOMS TREATMENT: PHARMACOLOGY PAIN–Jaw, back, mid back/shoulder pain, heartburn (epigastric), Substernal Key words = priority: “Sudden” “Crushing” “radiating” NCLEX TIP SOB “dyspnea” “labored breathing” NAUSEA Vomiting “Abdominal pain” SWEATING “Diaphoresis” PALE COOL SKIN “dusky” ANXIETY CAUSES SODDA S–Stress, Smoking, Stimulants (caffeine, amphetamines) O–Obesity–(BMI over 25) D–Diabetes & HTN (over 140/90) D–Diet (high cholesterol) animal fats A–African American males & Age (over 50) *Men more than women PROGRESSION PATHO MI=Heart muscles DIE “necrosis” (minutes = muscle death) Blockage of Coronary Artery “O2 Tube” DIAGNOSTICS 1st–EKG (Any chest pain or MI symptoms) DURING–Any Chest Pain O–Oxygen A–Asa N–Nitro–under tongue x 3 Max M–Morphine - Any pain after = MI (injury) AFTER–MI Clot Stabilization: Heparin: prevents CLOT growth (NOT dissolve only t-PA) PTT: 46 - 70 “3 x MAX” Antidote: Protamine Sulfate Memory Trick: “HaPTT” frog Heart Rest: B–Beta Blockers (-lol) Atenolol Blocks both BP & HR (Lol = Low BP & HR) CAUTION: B–Bad for Heart Failure patients (CHF) B–Bradycardia (60 or Less) & BP low (HR LESS than 60) B–Breathing Problems “wheezing” (Asthma, COPD) B–Blood sugar masking “hides s/s” (Diabetics) C–Calcium Channel Blockers Calms BP & HR-(AVOID Low Hr & BP) (Nifedipine, Diltiazem, Verapamil) CAM C–CAD “coronary artery disease” A–ACS “acute coronary syndrome” “Ischemic heart disease” -dipine “declined BP & HR” -zem “zen yoga for heart” -amil “chill heart” D–Dilators (vasOdilators = O2 to heart) Angina - Stable “Safer”- relieved w/rest Angina - Unstable “Unsafe” - Unrelieved M–MI (heart die) PATIENT EDUCATION DRESS D–Diet low (sodium & fluids (2g/2L per day) Prevent HF Heart Failure=Heavy Fluid Report "New, Rapid" Weight Gain-Water Gain! R–Reduce Stress, Alcohol, Caffeine, Cholesterol (animal fats) E–Exercise (30 min x 5 days/wk) S–Smoking Cessation S–Sex (2 flights of stairs with NO SOB) NCLEX TIP *AVOID NSAIDS (naproxen, ibuprofens) = increases CLOT risk! 2nd–LABS T–Troponin (Over 0.5 ng/mL) T–Trauma (ONLY indicator of MI) Other labs: Crp, Ckmb, Myoglobin, CRP (inflammation) TREATMENT: PHARMACOLOGY AC A C A–Antiplatlet HOLD if: Platlets 50K or LESS “below 50 gets risky” (not INR, not aPTT) A–ASA C–Clopidogrel C–Cholesterol Lowering “-Statin” Lovastatin “stay clean” CAUTION: NO grapefruit Liver Toxic–report “clay colored stools” Muscle pain (Rhabdomyolysis risk) Late night–take at dinner Nitroprusside (only for HTN crisis) & Isosorbide Nitro “Pillow for heart” NO viagra “-afil” Sildenafil = DEATH! Nitro drip: STOP if Systolic BP below 90 or 30 mmHg Drop SE: HA is Common + SLOW Positions changes “syncope” DISCHARGE–GOING HOME Heart Rest: 1st choice A–Ace (-pril) Lisonopril “chill pril” 2nd choice A–ARBs (-sartan) Losartan “relax man” Antihypertensive (BP ONLY) *HOLD: Low BP (not HR) A–Avoid Pregnancy A–Angioedema “thick tongue” (Airway Risk) *only Ace *NCLEX TIP* C–Cough *only Ace Creatinine (Kidney) (normal: 0.9 -1.2) *only Ace E–Elevated K+ (normal 3.5-5.0) *NCLEX TIP* AVOID Salt Substitues + Green Leafy veggies • 1st–Cardiac Monitor • High Potassium = High Pump • Monitor: muscle cramps, spasms, peaked T waves, ST changes CATH LAB C–Contrast = Kills Kidneys “Angioplasty, Angiogram, CABG” A–Allergy to Iodine (warm flushing normal) B–Bleeding–direct manual pressure (above site)