NCM 118 RLE: Critical Care | MIDTERMS

Prof. Luce, Prof. Malicsi, Prof. Fernandez, Prof. Sumilang & Prof. Dizon RN, MAN | WEEK 7-8

TABLE OF CONTENTS Week 8: Cardiac Catheterization, Angiogram, and

Week 7 • Sterile Field Angioplasty
Activities for this Week: • Types of Coronary (Lecturer: Prof. Maharlika Levi M. Sumilang RN, MAN)
• Assessment of the Artery
Heart (Group • Protection CORONARY ANGIOGRAM
Assessment) • Patient Preparation • Coronary angiography is a procedure that uses a
• Supplemental • Things to Remember special dye (contrast material) and x-rays to see how
Videos (Links) • Procedure contrast material filled blood flows through the
• Continued coronary arteries of the heart
Week 8 • Complications
IMPORTANCE OF CORONARY ANGIOGRAM
Cardiac Catheterization, • Health Teaching
Angiogram, and Angioplasty • Additional Info • Coronary Angiogram, is the “gold standard” for the
I. Coronary Angiogram XX. Supplemental Video evaluation of Coronary Artery Disease
• Definition • A coronary angiogram can be used to identify the
II. Importance of Coronary Cardiac Drugs exact location and severity of CAD.
Angiogram I. Antiarrhythmic Drugs
III. Indications II. Causes of Arrhythmias
INDICATIONS
IV. Contraindications III. Classes of Arrhythmic Drugs
V. Requisite for Coronary IV. Supraventricular • Acute MI
Angiogram Tachycardia (SVT) • Unstable Angina
VI. Contrast Media V. Cardiac Drugs • Chronic Unstable Angina (uncontrolled by….)
VII. Steps of Coronary • Lidocaine
Angiogram • Cordarone • Abnormal stress test
VIII. Coronary Anatomy • Atropine • Ventricular arrhythmias
IX. Dominance • Epinephrine • Left ventricular dysfunction
•
X. Left Main Coronary Artery
(LMCA) •
Dopamine
Dobutamine
• Valvular heart disease
XI. Left Anterior Descending • Norepinephrine • Preoperative coronary assessment for cardiovascular
Artery (LAD) • Furosemide surgery
XII. Left Circumflex Artery • Potassium Chloride • Periodic follow up after cardiac transplantation
(LCx) • Nicardipine
XIII. Right Coronary Artery • Isosorbide Dinitrate CONTRAINDICATIONS
(RCA) • Lanoxin
XIV. Normal Coronaries • Heparin • Coagulopathy
(LCA) • Tirofiban • Active bleeding
XV. Complication • Protamine Sulfate • Malignant hypertension
XVI. Management of
Complication
VI. Statins
VII. Aspirin
• Acute or chronic renal failure
XVII. Contrast Nephropathy VIII. Clopidogrel • Severe anemia (Hb < 10 gm/dl of blood)
(CIN) IX. Warfarin • Electrolyte imbalance
XVIII. Follow-Up X. Beta-Blockers • Fever
XIX. Angioplasty XI. ACE Inhibitors
• Indication • Active systemic infection
• Relative Supplemental Video Links on • Uncontrolled rhythm disturbances (arrhythmias)
Contraindication Cardioversion and Defibrillation • Uncompensated heart failure
• Vascular Access (Asynchronous)
• Transient ischemic attack
• Patient unable to cooperate or does not desire
WEEK 7 procedure
Assessment of the Heart (Group Assessment)
Supplemental Links REQUISITE FOR CORONARY ANGIOGRAM
• Preparing for Your Thoracic Surgery | UCLA Health: • Cardiac cath lab
https://www.youtube.com/watch?v=Csobq6a_tko
• Puncture needle
• Robotic-Assisted Minimally invasive Thoracic Surgery • Introducer
| Memorial Sloan Kettering:
https://www.youtube.com/watch?v=cnzR8BZrLZI
• Short guide wire

• Thoracic Surgery Techniques: Approaches Using

• Cordis sheath with dilator
HARMONIC ACE | Ethicon: • Left Judkins catheter
https://www.youtube.com/watch?v=A9NijvIlLw4 • Right Judkins catheter
• Intubation & Mechanical Ventilation: o For visualizing the right coronary artery
https://youtu.be/V8VIw0fk4X0 • Contrast media
• Tracheostomy Care: • Tiger Catheter for Trans radial
https://www.youtube.com/watch?v=Wimw7bz0fLo o Multipurpose catheter
• Closed Suction for Tracheostomy Patients with o TIG
COVID-19: https://youtu.be/6Bj47DLY6Sk o Used for trans radial angiogram
Approach is radial artery
• Mechanical Ventilation in Nursing (Uploaded Video)
o
o Visualize right and left coronary arteries
• Assisting During Endotracheal Intubation (Uploaded o Only catheter that can visualize both
Video)

NCM 118 RLE TRANS/NOTES #1 | AAA & ARMDT


CONTRAST MEDIA
• Types of radiocontrast agent (Iodinated radio
contrast agents are either ionic or nonionic and are
of variable osmolality):
o First Generation
▪ Ionic
▪ Highly hyperosmolal (1400 to 1800
mosmol/kg compared with the
osmolality of plasma)
o Second Generation
▪ Lohexol,
▪ Nonionic monometers
▪ Lower osmolality than the
first generation (have an
increased osmolality 500-
850 mosmol/kg)
compared with plasma
▪ The newest nonionic contrast
agents:
▪ Iso-osmolal with an
osmolality of
approximately 290
mosmol/kg (iodixanol
agent)
• Low impact to kidneys - second generation
STEPS OF CORONARY ANGIOGRAM
• Step 1 (Pre-cath):
o Written consent
o Fasting for at least 4 hours
o Pre-cath investigations
o Selection of arterial access point
o Shaving of the groin/wrist according to the
choice
o Opening the I/V line
o Connect with the cardiac monitor
o Oral or I/V sedatives
• Step 2
o Radiation protection for the health care
personnel
o An area of the arm or groin is cleaned and
numbed with a local numbing medicine
(anesthetic 15mL)
o Draping of the patient
o Using local anesthetics around the puncture
site
o Puncture and introducing the short guide
wear through the puncture needle
o Introducing the cordis sheath and removal
of dilator along with short guide wire
o Flush the channel with heparinized solution
• Step 3
o The cardiologist passes a thin hollow tube,
called a catheter, through an artery and
carefully movies it up into the heart. X-ray
NCM 118 RLE TRANS/NOTES #1 | AAA & ARMDT
images help the doctor position the
catheter.
o Once the catheter is in place, dye (contrast
material, better to use <30 mL to prevent
CIN) is injected into the catheter.
o X-ray images are taken to see how the dye
moves through the artery. The dye helps
highlight any blockages in blood.
CORONARY ARTERY
• The left and right coronary cusp give rise to their
respective coronary arteries
• The major epicardial vessels are the left main
coronary artery that divides into the Left Anterior
Descending Artery and Left Circumflex Artery, and
respective coronary arteries, the Right Coronary
Artery.
DOMINANCE
• Coronary dominance is based on the vessel that
gives rise to the posterior descending artery which
supplies the Atrio-ventricular node.
• Recognized by the presence of septal perforating
branches, arises from the RCA in 80% and from the
LCX in 10% of the population
• Co-dominance is found in 10% of the population
where the posterior interventricular artery is formed
by both the RCA and LCx.
LEFT MAIN CORONARY ARTERY (LMCA)
• The Left main coronary artery originates from the left
coronary cusp and bifurcates to give rise to the Left
Anterior Descending and Left Circumflex arteries.
• Long LMCA when the length is > 15 mm
• Short LMCA when the length is < or = to 5mm
• Occasionally, a 3rd branch vessel, the Ramus
Intermedius arises from the LMCA
• In a small number of patients, the 2 major branch
vessels arise from separate origins
LEFT ANTERIOR DESCENDING ARTERY (LAD)
• LAD provides blood supply to the anterior wall of the
left ventricle
• It provides multiple septal branches to the anterior
lateral wall
• The LAD in some patients wraps around the apex to
supply a small amount of the posterior apex
LEFT CIRCUMFLEX ARTERY (LCx)
• LCx courses around the lateral of the left atrio-
ventricular groove and gives rise to multiple marginal
or lateral branches. The branches are termed obtuse
marginal (OM) branches.
• OM branches are sequentially numbered (OM1,
OM2, etc…)
• As the LCx courses the AV groove it also gives rise to
several atrial branches, and occasionally the sino -
atrial branch (40% of the population)
LEFT CORONARY ARTERY (RCA)
• RCA arises from the right coronary cusp and follows
the right AV groove
• The most proximal branches of the RCA are the
conus-branch which supplies the right ventricular
outflow tract and a branch that supplies the sino -
atrial (SA) node (60% of patients)
• RCA gives off the postero-lateral and posterior
descending branches at the crux cordis
 NORMAL CORONARIES (LCA)
• Right Side
o Longest one - left anterior descending (LAD)
• Left Side
o Left circumflex (LC)
• Branches on those vessels
o LAD : diagonal 1 & 2
o LC: Obtuse branch 1 & 2
COMPLICATIONS
• Life threatening complications are rare (~1 in 1000)
but more common in patients with serious disease
(e.g. Left main stem disease, aortic or peripheral
vascular disease).
• Major Complications:
o MI
o Stroke
o Renal failure
o Aortic or coronary dissection
o Cardiac rupture
o Air embolism
o Arrhythmia
o Peripheral vascular damage
• Minor Complications:
o Hematoma (at the puncture site)
o Angina
o Vasovagal reaction
o Allergies to contrast agents and drugs
MANAGEMENT OF COMPLICATIONS
• Hematoma
o Most hematomas don’t need intervention.
Only analgesia
o If it is tense, expansile, bruit, or very tender
then the alternative diagnosis will be
femoral artery pseudoaneurysm.
• Pseudoaneurysm
o Represents partial rupture of the femoral
artery with formation of false aneurysm.
Diagnosed by ultrasound
▪ Small - prolong compression for 20-
30 minutes under ultrasound
guidance
▪ Large - needs surgical repair
• Hemorrhage
o Despite prolong pressure more than 30 min
then use mechanical clamp or hemostatic
device
o Check for coagulation profile
o To reverse the effect of heparin use
protamine and for warfarin use factor IX
concentrate
• Limb Ischemia
o Rare but usually occurs in patients with
significant peripheral vascular disease
o Check for the peripheral pedal pulses
before and after angiogram for comparison
• Contrast and Protamine Reaction
o Mild reaction: Urticarial, mild fever and
rigors - IV or oral chlorpheniramine 10mg
o Loin pain due to protamine:
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▪ IV hydrocortisone (100-200mg)
▪ IV chlorpheniramine (10mg)
▪ Opiate analgesia
• Anaphylaxis
o IV hydrocortisone 200mg
o IV chlorpheniramine 10mg
o IM adrenaline 0.5-1mg
o Plasma expander
• Vasovagal Reaction
o The patient will develop hypotension and
bradycardia
▪ Disengage catheter
▪ Elevate patient’s leg
▪ IV atropine 1mg
▪ IV plasma expander 200-500mL
rapidly
CONTRAST NEUROPATHY (CIN)
• Radiocontrast media can lead to an usually
reversible form of acute kidney injury (formerly called
ARF) that begins soon after the contrast is
administered. In most cases, there are no permanent
sequelae, but there is some evidence that its
development is associated with adverse outcomes.
• Contrast-mediated nephropathy (CIN) was defined
by an absolute increase of serum creatinine greater
than or equal to 0.5 mg/dL or a relative increase of
greater than or equal to 25% measured 2 to 5 days
after the procedure (AHA).
FOLLOW-UP
• Check for the peripheral pulses, local temperature of
the limbs and any abnormal feelings like numbness,
coldness, etc.
• Check for the body temperature
• Check for the hematoma, rashes, loin pain
• Ask the patient for any chest pain or discomfort
• Check for the urinary output
• Advice the patient to immobilize the limb where the
procedure was done for several hours
ANGIOPLASTY
• Percutaneous Coronary Intervention (PCI), commonly
known as Percutaneous Transluminal Coronary
Angioplasty (PTCA), is a non-surgical procedure used
to treat the stenotic coronary arteries found in
Coronary Artery Disease (CAD)
• The term PCI now encompasses the broad array of
balloons, stents, and adjunctive devices required to
perform safe and effective percutaneous
revascularization in complex coronary artery lesions
INDICATION
• ST Elevation MI
• Non ST elevation MI
• Unstable angina (refractory to medical
management)
• Unstable angina
RELATIVE CONTRAINDICATION
• Presence of any significant comorbid condition that
severely limits lifespan of patient
• Multivessel coronary artery disease
• Active bleeding/hemorrhagic stroke
• Abnormal serum creatinine level
• Active endocarditis
• Severe coagulopathy
• Critical electrolyte imbalance
 VASCULAR ACCESS
• Femoral artery
• Brachial artery
• Radial artery
EQUIPMENT
• Room equipment: C-arm, monitoring device, couch,
ECG
• Procedure Equipment:
o Sheath
o Wire
▪ Goes directly to the coronary
artery
o Catheter
o Stent
o Balloon
o Extension inflator, contrast media, saline
flush, nitroglycerine, needle, syringe, gauze,
alcohol swab, etc
STERILE FIELD
• The equipment used in the procedure are
completely sterile
TYPES OF CORONARY STENT
• Stents - used to widen the lumen of the coronary
arteries for revascularization
• 3 Types of Stents:
o Bare Metal Stent (BMS) - obsolete
o Drugs Eluting Stent (DES) - 2.0 mcg Sirolimus;
contains medications; commonly used
o Bioabsorbable Stent (BAS) - commonly
used; becomes a part of the artery wall;
more expensive; only 1 manufacturer have
this kind of stent
• In FEU-NRMF we use 2 and 3
PROTECTION
• Lead apron of 5mm lead equivalent is worn during
the procedure
• Lead glass radiation shielding is used
PATIENT PREPARATION
• Patient may be required to be admitted to hospital
the night before the procedure. For some patient,
overnight stay is not required as it can be done via
outpatient department services
• Medical history of patient including allergies and
medication
• Nil per oral 6-8 hours before the test
• Check vital signs and send blood investigations and
report should be collected
• Client and his guardian should be explained about
procedure along with its associated risk and
outcomes
• Client should be informed about procedure price
and explained about price of stent and its function
• Consent form should be signed before procedure
• Any questions or doubts should be asked and
clarified with doctors before surgery.
• Patient should be asked to empty bladder and
change into a hospital gown
• Armpit or groin area shaving is required
• IV line is inserted before the procedure
THINGS TO REMEMBER
• Before PCI, chewable tab Aspirin 300mg and tab
Clopidogrel 300-600mg is given (even to the patient
on Warfarin therapy)
NCM 118 RLE TRANS/NOTES #1 | AAA & ARMDT
• There is no additional need of Heparin in patient who
undergo PCI while Therapeutic on Warfarin (INR = 2-3)
• In patient with severe chest pain, Tab NTG 0.4mg
sublingually in q5mins up to 3 times
• Diabetic medicine Tab Metformin is held before
cardiac catheterization and lactic acidosis
o Normoglycemia is no more recommended.
Instead, Insulin Infusion to maintain glucose
levels <180mg/dL - > 90mg/dL is
recommended
o If creatinine level is more than equal to 3,
PCI isn’t recommended. Hydration therapy
and dialysis is planned first
PROCEDURE
• Radial access:
o Place a needle to the anterior radial artery
• A flexible catheter is slipped over the wire and
guided up to the heart. This is monitored using
continuous x-ray imaging device called Fluoroscope
and this point, a guidewire is removed
• A special dye is injected that allow fluoroscope to
xray images of anterior interiors and helps in
identifying the position of plug
o This is called Angiogram
• Once the blockage is identified, a flexible guide wire
is inserted into artery vessels followed by a balloon
tipped catheter over this wire to position itself at the
site of blockage.
• Rapid inflation and deflation of the small balloon
pushes the vessels valve out reestablishing the flow of
blood in the artery
• After the blocked vessels is reopened the deflated
balloon catheter is withdrawn from the artery
• Some treatment procedure is repeated in case of
multiple vessels blockage
o This is known as balloon angioplasty
• Once it has been treated, a collapsed stent is placed
over the deflated balloon catheter as it is inserted
into the vessel
• When balloon inflated the stent expands and locks
itself into the cage
• deflated balloon catheter are withdrawn leaving
stent behind to hold artery open permanently
• Again dye is injected, x-ray is taken
CONTINUED
• In radial access, patient is allowed for ambulation
within 2 hours but should remain on bed for at least 3
hours or until effect of sedatives disappeared
• In femoral access, 4 to 6 hours bed rest compulsory;
seth is removed after 2-3 hours (vasovagal reaction
may occur so IV atropine should be kept ready for
bolus); after applying manual pressure elastic
bandage is done along with compression ball
o Femoral access - 24 hours bed rest
• Patient is strictly prohibited to repetitive movement of
affected arm or leg for 24 to 48 hours (one can turn
laterally keeping leg straight)
• Input output monitoring; contrast induced
nephropathy monitoring should be done
• After 2 hours, sips to normal diet is allowed
• If no complication arises, patient gets discharged on
the next day
 COMPLICATIONS
• Myocardial infarction
• Arrhythmias
• Contrast agent reaction
• Perforation of heart chambers
• Misplacement of stent
• Infection in the surgical cut
• Kidney failure (higher risk who already had kidney
problem)
• Stroke (rare)
HEALTH TEACHING
• If groin artery was used for net 24 hours, don’t bend
waist or lift heavy object
• Don’t submerge puncture site in water
• If bleeding occurs, lie down and apply pressure for 10
minutes and then contact care provider
• Consult primary care provider if fever, swelling, new
bruising or pain arises
• Not to discontinue any medicine without consulting
concerned physician
• Lifestyle modification:
o Low cholesterol
o Low fat
ADDITIONAL INFO
• Nitroglycerine - increases vascular load, expands
coronary vessels (dilator)
• To prevent vasoconstriction, it is given to clients
before procedure (1 mg)
SUPPLEMENTAL VIDEO
• Coronary Angiogram (Full length procedure)
o https://www.youtube.com/watch?v=F2bJF
DvDVxg
Cardiac Drugs
(Lecturer: Prof. Jeanette Luce RN, MAN)
NOTE: For the drug computations, kindly refer to the
uploaded pdf file on Moodle with the file name: Emergency
Drugs ☺
ANTIARRHYTHMIC DRUGS
• Antiarrhythmic agents are groups of drugs that are
used to suppress abnormal rhythms of the heart, such
as atrial fibrillation, atrial flutter, ventricular
tachycardia, and ventricular fibrillation.
• Atrial Fibrillation
o Irregular heartbeat (arrhythmia) that can
lead to blood clots, stroke, heart failure, and
other heart-related complications
• Atrial Flutter
o Abnormal heart rhythm (arrhythmia). It
occurs when a short circuit in the heart
causes the upper chambers (atria) to pump
very rapidly.
• Ventricular Tachycardia (VT)
o Fast, abnormal heart rate
o Starts in your heart’s lower chambers, called
the ventricles. VT is defined as 3 or more
heartbeats in a row, at a rate of more than
100 beats a minute. If VT lasts for more than
a few seconds at a time, it can become
life-threatening.
• Ventricular Fibrillation (V-fib)
o Dangerous type of arrhythmia or irregular
heartbeat
o It affects your heart’s ventricles. Your heart is
a muscle system that contains 4 chambers:
the bottom 2 chambers are the ventricles. In
NCM 118 RLE TRANS/NOTES #1 | AAA & ARMDT
a healthy heart, your blood pumps evenly in
and out of these chambers.
CAUSES OF ARRHYTHMIAS
• Certain conditions can lead to, or cause an
arrhythmia including:
o A heart attack that’s occurring right now
o Scarring of heart tissue from a prior heart
attack
o Changes to your heart’s structure, such as
from cardiomyopathy
o Blocked arteries in your heart (coronary
artery disease)
o High blood pressure
o Overactive thyroid gland (hyperthyroidism)
o Underactive thyroid gland (hypothyroidism)
o Diabetes
o Sleep apnea
o Infection with COVID-19
• Other things that can cause an arrhythmia include:
o Smoking
o Drinking too much alcohol or caffeine
o Drug abuse
o Stress or anxiety
o Certain medications and supplements,
including over the counter cold and allergy
drugs and nutritional supplements
o Genetics
CLASSES OF ARRHYTMIC DRUGS
• Class I: Membrane-stabilizing
o (Ia) procainamide, disopyramide,
o (Ib) lidocaine,
o (Ic) Flecainide
• Class II: Reduce adrenergic input
o Beta-blockers
• Class III: Potassium blockers
o Amiodarone, Sotalol
• Class IV: Calcium influx blockers
o Verapamil (but not dihydropyridines)
SUPRAVENTRICULAR TACHYCARDIA (SVT)
• Condition where your heart suddenly beats much
faster than normal
• A fluttering or pounding in your chest (palpitations)
• A pounding sensation in the neck
• Weakness or feeling very tired (fatigue)
CARDIAC DRUGS
• Lidocaine
o Local anesthetic used in a wide variety of
superficial and invasive procedures
• Cordarone
o Used to treat and prevent an irregular
heartbeat
o It slows down nerve activity in the heart and
relaxes an overactive heart
o Relaxes an overactive heart
• Atropine
o The use of atropine in cardiovascular
disorders is mainly in the management of
patients with bradycardia. Atropine
increases the heart rate and improves the
atrioventricular conduction by blocking the
parasympathetic influences on the heart.
• Epinephrine
o Causes constriction in many networks of
minute blood vessels but dilates the blood
vessels in the skeletal muscles and the liver.
In the heart, it increases the rate and force
of contraction, thus increasing the output of
blood and raising blood pressure.
 • Dopamine
o It is a catecholamine neurotransmitter used
to treat hemodynamic imbalances, poor
perfusion of vital organs, low cardiac
output, and hypotension
o Cannot be given thru IV push
• Dobutamine
o It is a beta-1 agonist used to treat cardiac
decompensation in patients with organic
heart disease or from cardiac surgery.
o Indicated when parenteral therapy is
necessary for inotropic support in the short -
term treatment of patients with cardiac
decompensation due to depressed
contractility resulting from either organic
heart disease or from cardiac surgical
procedures
• Norepinephrine
o Increases blood pressure, helps increase
blood sugar level and breakdown of fats to
provide more energy to the body
o Inotropic drug
o Cannot be given thru IV push
o Initial dose: 0.5mg/hr (before). Currently, the
initial dose starts with 0.1mg, 0.2, etc
• Furosemide
o It is loop diuretic medication used to treat
fluid build-up due to heart failure, liver
scarring, or kidney disease. It may also be
used for treatment of high blood pressure. It
can be taken by injection into a vein or by
mouth.
o Check BP before administering
o Slow IV push
o Monitor I&O after giving Furosemide
• Potassium Chloride
o Mineral that your body needs for proper
functioning of the heart, muscles, kidneys,
nerves, and digestive system. Certain
diseases, illnesses, and drugs can remove
potassium from the body.
o Cardiac enzyme
o Do not give IV push because it can cause
tachycardia leading to cardiac arrest
o This is an irritant
• Nicardipine
o Used to treat high blood pressure and to
control angina (chest pain).
o Nicardipine is in a class of medications
called calcium channel blockers. It lowers
blood pressure by relaxing the blood vessels
so the heart does not have to pump as
hard.
o Start 1mg/hr; maximum dose is 8mg/hr
o Single concentration (80cc per hour)
o Double concentration (40cc per hour)
o Quadruple concentration (10 cc per hour)
o Can be given concentrated; use syringe
and infusion pump
• Isosorbide Dinitrate
o Type of vasodilator
o It relaxes blood vessels, increasing the blood
and oxygen supply to your heart. This
medicine is used to prevent chest pain
caused by angina. It will not help to stop an
episode of chest pain.
• Lanoxin
o Indicated for the control of ventricular
response rate in adult patients with chronic
atrial fibrillation.
o Check PR & CR before administration
NCM 118 RLE TRANS/NOTES #1 | AAA & ARMDT
• Heparin
o It is used as an anticoagulant. Specifically it
is also used in the treatment of heart attacks
and unstable angina.
o Can be given 10,000 U during angioplasty
o Green vial: 5,000 units per vial
o Blue vial: 25,000 IU
• Tirofiban
o Blocks platelets from forming blood clots
o It is used to prevent complications during
episodes of chest pain or a heart attack, or
during a procedure to treat a blocked
artery of the heart
o Can be given thru IV push but depends on
the weight of the patient
• Protamine Sulfate
o Medication that is used to reverse the effect
of heparin
o It is specifically used in heparin overdose, in
low molecular weight heparin overdose,
and to reverse the effects of heparin during
delivery and heart surgery.
o Given by injection into a vein.
STATINS
• Lower LDL cholesterol
• They lower the “bad” LDL cholesterol levels by 20 to
60% and also reduce inflammation. Most people who
have had a heart attack or stroke, bypass surgery,
stents, or diabetes should be taking statins. Some
patients with a high LDL level, but without heart
disease, should also take statins.
ASPIRIN
• To prevent blood clots
• Aspirin has been around for a long time and was first
discovered to have cardiovascular benefits in the
1960s.
• Aspirin can help to keep your arteries open because
of its anti-clotting and anti-platelet effects.
• A standard dosage for heart patients is 81 mg a day,
which is one baby aspirin. Aspirin makes sense for
people who already have heart disease, but not
necessarily for people who just have risk factors.
• Sometimes given in combination with Clopidogrel
(given during AM), while Aspirin (after lunch)
CLOPIDOGREL
• To prevent blood clots
• This drug is considered a “super-aspirin” because of
its effectiveness in preventing platelet clumping, and
it’s often used in combination with aspirin. For some
patients there is an increased risk of bleeding and
doctors will weigh the benefits versus the risks of this
drug. However, if you have a stent, the combination
of aspirin and clopidogrel is essential to preventing
clotting. It’s also often used for patients with
worsening angina.
WARFARIN
• This drug is a stronger anti-clotting agent than aspirin
and clopidogrel.
• It works as an anticoagulant – or blood thinner.
• Warfarin was widely used in the past to prevent the
formation of clots if you have atrial fibrillation, an
artificial heart valve or if you have blood clots in your
legs.
BETA-BLOCKERS
• To treat heart attack and heart failure and
sometimes used to lower blood pressure
 • Beta-blockers block the effects of adrenaline, which
comes on in response to stressful situations.
• Beta-blockers are prescribed in the treatment of
these four conditions:
o Angina
o Heart attack
o Congestive heart failure
o Abnormal heart rhythms
• Dosage of these medications must be adjusted for
the desired response. Your doctor will monitor you for
dizziness (due to low heart rate) kidney and liver
problems.

ACE INHIBITORS
• To treat heart failure and lower blood pressure
• ACE (angiotensin-converting enzyme) inhibitors
prevent the body from producing the artery-
constricting hormone angiotensin. Arteries relax with
ACE inhibitors and this lowers blood pressure.
• They are prescribed for patients with congestive
heart failure, a recent heart attack, and those with
hypertension.
• Collectively, these drugs save lives by preventing
heart attacks and strokes. Chances are you will take
one or more of these medications if you are at risk for
or have coronary heart disease.
• Be sure to know your medications and follow your
doctor’s instructions. You’ll want to work with them to
get the safe and effective combination for you.

Supplemental Video Links on Cardioversion & Defibrillation

(Asynchronous)
Prepared by: Prof. Kenneth Dizon RN, MAN
• Synchronized Cardioversion vs. Defibrillation:
https://www.youtube.com/watch?v=QrieZtxcKk4
• How to perform Cardioversion and Defibrillation:
https://www.youtube.com/watch?v=T7Zv9vLdWtE
• Cardioversion: https://youtu.be/dC_i8zuclmQ

NCM 118 RLE TRANS/NOTES #1 | AAA & ARMDT