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