The American College of Cardiology (ACC) and American Heart Association (AHA) released the guidelines on the management of STEMI and NSTEMI in 2013 and 2014, respectively. Mrs. B will be treated based on these guidelines. Immediately on arrival, she will receive the following treatments: supplemental oxygen therapy to keep oxygen saturation greater than 90% or relieve respiratory distress, sublingual nitroglycerin to relieve ischemic pain, and chewable 325mg aspirin for its antiplatelet effect. Morphine sulfate will be considered if chest pain is not relieved by sublingual nitroglycerin or if anxiety or pulmonary edema is present. Following the initial treatment, the treatment plan for Mrs. B will depend on whether she is diagnosed with STEMI, NSTEMI, or unstable angina. Each case will be discussed briefly:
STEMI treatment. Mrs. B will receive a loading dose of 600mg clopidogrel and will be started on heparin drip. Reperfusion therapy needs to be performed as soon as possible. PCI is the preferred method, and the goal is 90 minutes or less door-to-balloon time. If PCI is not available, fibrinolytic therapy should be administered unless it is contraindicated.
NSTEMI or unstable angina treatment. Mrs. B …show more content…
B will be monitored for the success of reperfusion therapy, arrhythmias, heart failure signs and symptoms, pericarditis, pericardial effusion, and cardiogenic shock. Post hospitalization, Mrs. B needs to establish care with a cardiologist. O 'Gara et al. (2013) recommend left ventricle (LV) function assessment for patients with lower LV function in 40 days. If LV function is not improved, the patient needs to be evaluated for implantable cardioverter defibrillator (ICD) insertion to prevent sudden cardiac death. Patients, especially those with drug-eluting stents, need to be monitored for antiplatelet compliance. Mrs. B will also need to follow up with her primary care provider for ECG, BMP, CBC, hemoglobin A1C, and