hey guys nurse Mike here and welcome to simplenursing.com before we get today's lecture started please remember to access your free quiz and preview our cool Nifty new study guides not here on YouTube click the link right up here at any time during this video today we're wrapping up heart attack or Mi that myocardial inunction so guys just think Mi the heart muscles die like all heart muscles the heart needs oxygen to pump and during a heart attack there is a blockage in one or more of these oxygen tubes called the coronary arteries and so the heart muscle suffocates to death over 500 cells die per minute and if blocked over 45 minutes these cells can die forever called necrosis so guys minutes equals muscle now what causes this narrowing well fatty deposits called plaque develops on the walls of the coronary arteries narrowing the vessels which makes it harder for oxygen to get to the heart and muscle so what causes this well just like hypertension use the acronym soda s for stress this can cause momentary narrowing so anxiety cold temperatures even physical exercise like sex and stimulants like caffeine even amphetamines like meth and adderal also Narrows the arteries momentarily but what really causes the most damage here are irritants found in smoking which scars the arteries and long-term obesity key term here guys a BMI over 25 but also diabetes and hypertension can cause stress stretching and tearing to the coronary arteries which severely damages them coupled with a bad diet high in cholesterol from animal fats like meats and dairies can cause fatty buildup getting stuck in the cracks and over time this growth makes the blood vessels stiffen hard something we call plaque this plaque causes hardening and narrowing in the arteries which is typically called atherosclerosis so just think arterio scaros hardening of the vessels from the scar Ing and plaque lastly heart disease is more common in African-American males an increased age over 50 and more common in men than women maybe women just handle stress better than men I don't know eventually too much plaque can turn into blockages and if one of these plaques ruptured usually from stress a blood clot can form in minutes and this blood clut can completely block all the oxygen to the heart muscle without oxygen heart cells die within minutes releasing proteins called troponin and guys this is the number one indicator of an MI but we're going to cover that in the diagnostic section now narrowing is classified into three sections under the big umbrella of es schic heart disease meaning a disease of lower oxygen to the heart and it comes in three sizes small medium and large kind of like a pizza so for small it's called coronary artery disease then stable angina the stress induced angina or basically chest pain now medium is a CS the acute coronary syndrome which encompasses unstable angina and Mi now unstable angina is our un safe angina which is unrelieved with rest and totally unpredictable far worse because it means we're closer to the larger condition of an MI and then to death so typically more pain experienced means more tissue death is occurring now as far as signs and symptoms any complaint of chest pain guys is super serious exams use the classic key words of left substernal pain but guys now boards are getting way more advanced so key wordss like sudden or crushing pain even radiating or shooting and even key word here heavy pressure usually indicates a priority so we'll see words for pain like substernal chest pain everyone knows that one but here's a big tip jaw pain left arm pain even midback or shoulder pain and even big one here heartburn or epigastric pain coupled with s SOB or shortness of breath dpia and even labored breathing now nausea and vomiting and abdominal pain not classic signs but big for Mi also sweating called diaphoresis and even pale cold skin known as Dusky and even anxiety now here's a tricky thing diabetic patients can have something called a silent Mi with no classic signs or symptoms guys they have dead nerves from diabetic neuropathy basically meaning they can't fill it and even women commonly tough it out thinking they're just tired or something so typically Mis and diabetics and women often go unnoticed now as far as diagnostics for Mi both labs and imaging any new chest pain always requires an EKG first big enlex tip and no you don't need to know how to read a 12 Le EKG for the en click or even the five other rhythms or views of an MI but you do need to know for the enlex St elevation and ST depression so St elevation usually means no O2 or it could mean hyperemia that high pottassium so we always confirm with troponin Labs so think if St is high then the heart muscles have died and if St is low we always think low O2 now this is called ST depression or t-wave inversion again caused by that low2 AKA eskee meaning only partial blockage or it could be from hypokalemia and typically St segments will go back to normal when we get reperfusion so we confirm it with blood Labs guys write this down troponin is our number one indicator for Mi it's our gold standard so again write it down troponin over 0.5 indicates trauma to the heart as heart muscles die this protein leaks out into the blood along with potassium so patients will also have high potassium AKA hyper calamia but are other labs like CK ckmb and even CRP these are important but guys they're not commonly tested on the enlex now a very common enlex question always shows an EKG with st elevation or gives you a positive tronent over 0.5 guys this always indicates an MI so we treat with drugs like Mona but we're going to cover that in a moment but guys the goal is always to unclog the oxygen tube within 45 minutes so patients are taken to the cath lab immediately to locate and fix the blockages we call the ABCs of Mi surgery an angioplasty AKA PCI is used to both visualize and move aside the blockages with either a balloon or stin a bypass also called cabbage to go around more severe blockages using a piece of vein or artery from another part of the body usually the leg or we can just cut out the blockage called an ARD ectomy now we can also use thrombolytics AKA claw Busters if surgery is not immediately available now these are called TPA or streptokinase but they're usually not routinely given as firstline therapy since they can cause massive bleeding and usually they have to be given within 2 to 6 hours of initial Mi but we're going to cover these treatments in the treatment section so now if tonin comes back negative meaning no M we commonly do a different test to diagnose the narrowing here this is called a stress test where we stress out the heart seeing how it responds with low oxygen it's all done to help pinpoint potential blockages so two types of stress tests are given either an exercise or treadmill stress test and non-exercise called nuclear pharmacology so exercise or treadmill stress test we're looking for St changes indicative of mardial esea basically low oxygen in the heart so remember the three s's during a stress test we stop for chest pain or St changes guys big test tip right there the enlex is going to ask for which immediate action by the nurse is of first priority now the answer is always to stop the test for St changes or chest pain now as far as non-exercise nucle stress test a radioactive die Tracer is injected into the vessels acting kind of like a highlighter to help pinpoint potential blockages now a big test tip before chemical stress test guys write this down huge enlex tips here since we're trying to diagnose narrowing we teach the patient to avoid the meds and stimulants that can alter the test now four big key terms always on select all that apply questions we avoid the C's and avoid the t's so 24 to 48 hours before we're always going to avoid cigarettes and caffeine including teas sodas and coffee guys not even decaf even decaf contains small amounts of Trace caffeine and we're avoiding cardiac meds like Nitro and beta blockers these two can relax the heart too much and are going to alter the test and lastly guys we're avoiding theop Ain the respiratory drug this guy acts like a stimulant causing narrowing so write that down theophine always comes up on exams here now one last tidbit here guys there's no eating or drinking 4 hours before and after the test we're not talking 12 here so just NP 4 hours before and after now for Mi treatments guys again think any acute chest pain we always have to think heart attack basically Mi the heart dies regardless if it's only a bad burrito or maybe it's just heartburn the thing is we don't know until we get an EKG and tronent so guys always think the worst so right now we give drugs to open up those oxygen tubes next we remove the blockage and after we give the heart rest and prevent any future clots now you've heard the term Mona but for the enlex the correct sequence is oxygen for perfusion aspirin are anti-platelet congreg to prevent platelets from sticking together and forming a bigger clot Nitro opens those coronary oxygen tubes to provide more oxygen to the heart muscle and morphine helps the heart to relax decreasing the workload now all these drugs help get and conserve oxygen immediately so big test tips for Nitro no Viagra aill ending drugs like zenail remember aill will kill since both are potent vasodilators it causes vascular collapse from low blood pressure now some other highly tested points here guys three doses a maximum of 5 minutes apart no swallowing always sublingual under the tongue and headache and orthostatic hypotension are common so guys we take this drug while sitting to prevent fall risk now a little side note for chronic angina patients at home we teach them to call 901 if there's pain 5 minutes after the first dose big enlex key term here guys pain 5 minutes after the first dose now test tips for morphine guys any chest pain after morphine indicates an MI even if it's only one or two out of 10 en's key word here is chest pain or unrelieved pain after morphing typically more pain equals more tissue death now we fix the clot with cath lab and clot Busters so for cath lab just think it clears the clot also called PCI percutaneous coronary intervention key terms that show up on exams are arterio or even angioplasty now angiography or even angiograms are images taken via x-rays to visualize the blockage and plasty means balloon or stent placement requiring more recovery time patients are usually awake not under general anesthesia so before were nopo 6 to 12 hours meaning no eating or drinking and after patients will lie flat for several hours and are encouraged to drink to dilute that contrast D which we'll be covering next now bypass also called open heart surgery requires more recovery time around 3 to 5 days in the hospital so words including bypass like coronary artery bypass graph or even midcab minimally invasive direct coronary artery bypass graphing usually a shorter recovery time because there's a smaller incision in between the ribs now post-operative general rules here we avoid lifting heavy objects and we protect incisions from infection so big no no here guys no baths or soaking the wound but shower is okay if they avoid soaking the wound underwater we want to prevent infection here so we monitor for redness warmth swelling and draining specifically at the incision site if there's any of these they we report it to the hcp immediately now test tips for cath lab guys always think contrast kills the kidneys usually used in procedures previously mentioned so contrast die also called iodine is a thick Dy highlighter used to find blockages and narrow but it's really hard for the kidneys to wash it out of the blood it's kind of like dumping cement into the washing machines of the body so think thick Dy the kidneys will die now here are the top seven test questions that come up with cath lab just remember the ABCs A for allergy to iodine and yes warm flushing is normal so guys allergies to shellfish is actually not used as a tool anymore to screen for iodine allergies according to the last enlex update B is for bleeding at the catheter site direct or manual pressure on or above the site for any potential bleed and patients will be lying flat hours after AKA supine so enlex key terms here guys write these down we're not putting the patient in semi fallers and no crossing the legs also no blood thinners within a 6-hour window this means no heprin no warin aspirin or even cigil now C is for creatinine always indicating kidney function Norm normally .9 to 1.2 so remember contrast kills the kidneys kind of like dumping that thick cement into a washing machine so creatinine over 1.3 usually means a injured kidney also called contrast nephropathy so we avoid renal failure patients and key word here guys write this down diabetics on Metformin we stop metformin 48 hours before and after the cath laap we want to prevent lactic acidosis and neph opathy and we can give mucus to protect the kidneys but it's not common on the enlex so remember iodine is like thick die the kidneys will die always a big unclick tip now the last C you can't palpate the pedal pulse after surgery guys we always call the doctor AKA hcp healthcare provider remember this pulses equals profusion normally we get diminished pulses but only 4 to 12 hours max not 1 to to two days so and collects key words here guys cold cool or remarkably cool legs absent pulses or non palpable or even just present with a Doppler ultrasound big No No Lack of profusion now we can also give clot Busters like TPA to dissolve the clot so let's review the top tested content right here from our DBT video now fiber analytics AKA clot Busters which are not routine for dvts but are still used these guys are like the atomic bomb they're onetime push drugs so we give either TPA or streptokinase but guys streptokinase has the most allergies associated with it and the big thing with these atomic bombs is the huge bleeding risk since it has an 8 hour or less duration this means we're most at risk to bleed during that 8 Hour window so guys no injections at all no new IVs no subq even for diabetics no IMS and definitely no abgs these drugs can only be given through a compressible site like an IV so we never give these through a central line because we can't hold pressure on that central line only peripheral lines here okay now after the Mi we want to prevent clots and give the heart some rest so Hein is used to stabilize unresolved clots and prevent the growth of current ones now big enlex key words here guys heprin does not dissolve clots only clot Busters dissolve clots like TPA and to give the heart some rest we use BCD drugs beta blockers calcium channel blockers and dilators like Nitro so here are the big enlex test tips for pharmacology again guys we took over 10,000 enlex questions here and here are the most tested key words write these down again heprin prevents clots by thinning the blood so we have a huge bleed risk so the therapeutic range for coagulation therapy is to keep the PTT between the ranges guys write these down 46 to 70 always on the enlex typically a standard is three times max range now the antidote for heprin is protamine sulfate so our memory trick is hepit like a frog just think H for Hein is hepit for PTT and protamine sulfate now for all the enlex keyword and memory tricks for beta blockers calcium channel blockers and dilators like Nitro we include all that stuff in our pharmacology section so we'll leave a link right here for the membership site now for complications after an MI like a car crash the heart has some pretty serious damage specifically to the left ventricle which happens to be the main pump giving oxygen and blood pressure to the entire body so when this guy fails we end up with some deadly complications so our three most deadliest complications here number one being cardiogenic shock we're talking BP so low it's on the flow so we watch for signs and symptoms of low cardiac output being low blood pressure pressure agitation or confusion cool and clammy pale white skin with low urine output less than 30 MLS per hour guys we need to increase that blood pressure fast with Epi dopamine and nor Epi now viib and Vac occurs in around 90% of recovering Mi patients yes that's correct guys 90% since the damaged heart sort of glitches or short circuits like a broken computer slipping into deadly rhythms like Vish and vtac so remember we always defibrillate if we don't have a pulse and always early defibrillation before CPR if given a choice big enlex tip we choose defib for viib and we also use cardiov version If You Can Count a pulse and always remember to synchronize lastly heart failure is a big issue or pump failure we call it since we have a damaged pump it fails to pump blood forward and now it backs up into the lungs and into our body eventually drowning the patient so remember HF in heart failure is HF for heavy fluid guys always report these key words rapid weight gain usually it means water gain worsening crackles can mean lung fluid and even sudden edema or jbd an even big key word here new S3 heart sounds or murmurs n collects keywords like rapid worsening and sudden usually indicates a priority patient always the number one intervention is push pushing IV diuretics like ferosa mide guys they end in eyed so think the body is dried and a little side note not is sorcer bide that's a nitrate for chest pain lastly two other conditions are common pericarditis and mitro valve prolapse in pericarditis the inflammation to the sac around the heart can lead to deadly pericardial infusions or cardiac tanod this is where the heart is basically squished to death by its own blood sack causing the heart to stop beating very common on the ankx since it's very deadly so guys we always monitor for Beck's Triad so remember Beck B for big jugular veins or jugular vein distension e for extremely low BP and C for you can't hear the heart sounds also called muffled or distant heart sounds now with mitro valve prolapse the little cords holding the valves can suddenly snap loose from a dead heart muscle now the patients will have a heart murmur and even develop atrial fib ation from blood backing up stretching out those Atria now after an MI we teach the two DS diet and lifestyle change and drugs or AKA pharmacology now it's not that we're just teaching them about diet and exercise we're nursing a broken heart here now our goal here is to prevent heart failure so the heart needs a few weeks off with less pressure and less workload now we do this with low sodium and low fluid intake so we educate the patient about the acronym dress so say yes to the address now D is for diet low in sodium and fluids so remember the two in two 2 G and 2 L per day or less this will reduce blood pressure and prevent heart failure so we watch for heavy fluid so we educate patients to take their own pulse guys write that one down big key word there we also do daily weights never weekly but daily and guys any rapid weight gain or any new edema or worsening dnia also called oropa we call the doctor these are early signs of heart failure and finally we teach the avoidance of high sodium foods like chips dressings ketchup Meats cheeses basically anything that comes in a package always remember here sodium swells the body and with heart failure we preventing heavy fluids now ours for reducing stress alcohol caffeine and here's a big one low cholesterol from animal fats so avoid animal products like beef poultry and dairy products like cheese and creams we're avoiding any and all land animals but fish that's okay now a side note again the numbers you need to know for the enlex all land animals increase bad cholesterol like total cholesterol triglycerides and ldls the loser lipids high cholesterol means High clogging and these numbers love to show up on the enlex and exam so guys write these down all these numbers should be low except hdl's the happy lipids the only only ones that should be high over 40 so hdls help get rid of the bad cholesterol and also eating fiber found in fruits and veggies can help clean out that cholesterol so listen to your mama and eat those veggies e is for exercise 30 minutes 5 days a week this not only increases htls those happy lipids but also strengthens the weak heart s is for smoking sensation big en click key term there guys it prevents scarring AKA AOS scaros and another key term term here guys is s for sex that's correct sex it can only be resumed only after climbing two flights of stairs with no shortness of breath big key word right there now a little test tip about therapeutic communication after an MI most patients don't even see a need to change but it's your responsibility as the healthcare provider to assess their fears guys by asking questions and teaching so big keywords for the test avoid keywords like accusing blaming and even asking why and speaking of things to avoid so we teach patients to avoid nids like keyw here guys ibuprofen and Naproxin those non-steroidal anti-inflammatory drugs these guys can cause an increased risk for thrombotic effects AKA a risk for clots and this causes future Mis now speaking of drugs we can always use the Aces and arbs to decrease the blood pressure now a lot of enlex questions come from pharmacology and we do a full video for both Aces and arbs and all the other cardiac drugs in the pharmacology section okay lastly we can give two very particular drugs that prevent future Mis let's play that segment right here so think AC for anti-logging of the arteries A is for anti-platelets like aspirin and cigil brand named Plavix this guy prevents platelets from clumping together and forming clock and C for cholesterol lowering drugs Guys these end in Statin like loast Statin so remember stay clean because it cleans out the arteries keeping them free from cholesterol now since statins prevent the production of cholesterol in the liver it is very liver toxic so guys don't give this to patients with liver problems like hepatitis or curosis oh and also avoid grapefruit juice since it blocks statin drugs all right guys that wraps it up for Mi don't forget to take your quiz in the practice area thanks for watching for our full video and new quiz Bank click right up here to access your free trial and please consider subscribing to our YouTube channel last but not least a big thanks to our team of experts helping us make these great videos all right guys see you next time [Music]