SIGNS & SYMPTOMS CAUSES PROGRESSION “Ischemic heart disease” 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! DRESS PATIENT EDUCATION C–CAD “coronary artery disease” A–ACS “acute coronary syndrome” Angina - Stable “Safer”- relieved w/rest Angina - Unstable “Unsafe” - Unrelieved M–MI (heart die) CAM 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 SODDA 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 DIAGNOSTICS 1st–EKG (Any chest pain or MI symptoms) 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 AC–Anti Clogging of Arteries TREATMENT: PHARMACOLOGY T–Troponin (Over 0.5 ng/mL) T–Trauma (ONLY indicator of MI) Other labs: Crp, Ckmb, Myoglobin, CRP (inflammation) 2nd–LABS Blockage of Coronary Artery “O2 Tube” MI=Heart muscles DIE “necrosis” (minutes = muscle death) PATHO MYOCARDIAL INFARCTION TREATMENT: PHARMACOLOGY 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) -dipine “declined BP & HR” -zem “zen yoga for heart” -amil “chill heart” D–Dilators (vasOdilators = O2 to heart) 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) Precautions: 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) NO=heparin, warfarin, ASA, clopidogrel C–Creatinine “Kidney” (normal: 0.9 - 1.2) REPORT: Creatinine Over 1.3 & Urine below 30 ml/hr STOP Metformin 48 hrs (before/after) C–Can’t feel pulses (Pulses = Perfusion O2) Diminished pulses (4-12 hrs post-procedure) MAX PRIOITY: Non palpable pedal pulse AFTER = CALL HCP (Dr.) Key words: “cool leg, pulse non palpable, present only with doppler US.” COMPLICATIONS AFTER MI ACUTE: (weeks after) Cardiogenic Shock (severe hypotension) V fib/V tach (no pulse) = DEADLY Defibrillate=Don’t have a pulse Cardioversion=Count a pulse *synchronize* CHRONIC: (lifetime) Heart failure “Heavy Fluid” Rapid weight gain (Water Gain), Worsening crackles (fluid in Lungs “pulmonary, edema”) Sudden edema (JVD, peripheral edema “+1 pitting”) #1 Priority–IV Diuretics–Furosemide, Bumetanide “dried” (NOT isosorbide) NitrOglycerin O2 to Heart PILL (or spray) S–Stable Angina S–Safe Angina S–Stops when activity STOPS (Stress Induced) *Take Before strenuous activity GOAL: NO chest pain=Daily activities “comb hair, fix hair, get dressed, make up, making bed etc.” TAKING MED: CALL 911: PAIN 5 min. After 1st dose. 3 doses max x 5 min apart NO SWALLOW–SL under STORAGE: NO LIGHT–NO HEAT NOT: pill box, car, plastic bag, pocket YES: purse ok *Replace every 6 months NO viagra “-afil” Sildenafil = DEATH! NORMAL ADVERSE EFFECT: HA=Normal Side Effect Hypotension=Adverse effect (need slow position changes) Nitro Patch (Transdermal nitro patch) U–Unstable Angina U–Unsafe Angina U–Unrelieved with rest /Unpredictable (anytime) 1 x daily NOT PRN 1 patch at a time NOT 2 patches YES Shower is ok LOCATION: Rotate locations Daily “Clean, Dry, shaven area” teach patient to wash hands after application Upper Body (subclavian, arm, upper chest) NOT: hairy, scarred, burned, callous NOT BROKEN SKIN *TEST TIP: Patch fall off? (Over 1 hour ago) Take nitro (pill/spray) New patch can take 40–60 min. *Nurses wear gloves! Will cause MAJOR HA if it comes into contact with skin! ANTICOAGULANTS (clot prevention) BLEED RISK(Patient Education) Antiplatelets (LESS potent) ASA & Clopidogrel Platelets LESS than 50k = RISKY (Normal: 150–400k) NOT INR or PTT Anticoagulants (MOST potent) Warfarin = INR “warINR” Range: 2.5–3.5 (3 x MAX range) Antidote: Vitamin K (green leafy veggies) *NOT K+ = potassium* Heparin (Enoxaparin) = aPTT “HaPTT” frog Partial Thromboplastin Time Range: 46–70 (3 x MAX range) Antidote: Protamine Sulfate NO peptic ulcers (or active bleeds) NO Rugs/dim halls (Well lit halls) NO razors, hard brushing, constipation NO NSAIDS like naproxen/ ibuprofen NO EGGO vitamins E–E Echinacea, A vitamin G–Gingko, Garlic, Ginseng O–Omega 3 MYOCARDIAL INFARCTION TREATMENT (+) Positive Troponin = Heart Attack (MI) PRIORITY: REMOVE THE CLOT! CLOT BUSTER “Thrombolytics, Fibrinolytics” t-PA: Alteplase, Streptokinase (Allergy risk) Dissolves Clot ONLY (heparin does NOT) BLEED RISK 8 hour duration NO injections (IV, SQ, IM, ABG) NOT via central lines (CVC) ONLY “compressible site” (IV, PICC) NOT FOR: Active Bleeds: Peptic Ulcers (but menstruation is safe) History: Arteriovenous malformations Intracranial “Cerebral” hemmorhage Hypoglycemia (relative contraindication) Hypertension (over 180/110) TEST TIP “CATH LAB” OR SURGERY “PCI” -graphy, -plasty BEFORE NPO 6 - 12 hrs AFTER NO heavy lifting–lie flat NO Baths–Shower ok (dont soak) Infected Incision “red, warm, drainage” STRESS TEST Non MI (Non priority) • Spot the Narrowing TREADMILL STRESS TEST STOP test: chest pain ST elevation CHEMICAL: NUCLEAR PHARMACOLOGICAL STRESS TEST 24–48 hours BEFORE NO Cigarettes, Caffeine (tea, soda, coffee) *NO DECAF NO Meds: Nitro, Beta Blocker, Theophylline (stimulant) NPO (nothing oral) 4 hrs before/after NOTES