NURS 287 Chapter Notes - Chapter 3: Left Coronary Artery, Angiotensin Ii Receptor Blocker, Coronary Circulation
28 Apr 2013
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Initial management of the patient with chest pain includes aspirin, sublingual nitroglycerin, morphine sulfate for pain unrelieved by nitroglycerin, and oxygen. Iv nitroglycerin, aspirin, -adrenergic blockers, and systemic anticoagulation with either low molecular weight heparin given subcutaneously or iv unfractionated heparin (uh) are the initial drug treatments of choice for acs. Iv antiplatelet agents (e. g. , glycoprotein iib/iiia inhibitor) may also be used if percutaneous coronary intervention (pci) is anticipated. Ace inhibitors help prevent ventricular remodeling and prevent or slow the progression of hf. They are recommended following anterior wall mis or mis that result in decreased left ventricular function (ejection fraction [ef] less than 40%) or pulmonary congestion and should be continued indefinitely. For patients who cannot tolerate ace inhibitors, angiotensin receptor blockers should be considered. Calcium channel blockers or long-acting nitrates can be added if the patient is already on adequate doses of -adrenergic blockers or cannot tolerate -adrenergic blockers, or has prinzmetal"s angina.
