Medical-Surgical Management

Ideal DIAGNOSTICS/ LABORATORY PROCEDURES Complete Blood Count (CBC)-This can detect Leukocytosis(WBC Count of 10, 000 to 20, 000) which usually appears, on the second day after Acute MI due to inflammatory process Chemistry-the basic metabolic panel (BMP) is a group of tests that measures different chemicals in the blood. These tests usually are done on the fluid (plasma) part of blood. The tests can give doctors information about your muscles (including the heart), bones, and organs, such as the kidneys and liver Troponin I- is a muscle protein that helps your muscles contract. When muscle or heart cells are injured, troponin leaks out, and its levels in your blood rise. Troponin are measured to differentiate between Unstable Angina Pectoris and Myocardial Infarction in patients with chest pain Electrocardiogram (ECG)-records the electrical activity of the heart. The heart produces tiny electrical impulses which spread through the heart muscle to make the heart contract. These can be used to detect various kinds of heart disorders Chest X-Ray-evaluates the organs and structure with the chest. May be used to detect enlarged cardiac shadow, suggestive heart failure, or show ventricular aneurysm, affecting ventricular wall motion Actual DIAGNOSTICS/ LABORATORY PROCEDURES DONE()

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Echocardiogram-A non-invasive test to evaluate the structure and motion of heart function, heart valves, and blood flow through the heart. Echocardiogram uses ultrasound (highfrequency sound waves) to create an image of your heart on a television screen (monitor). This test identifies whether an area of your heart has been damaged by a heart attack. Cardiac Catheterization & Coronary Angiogram- Cardiac catheterization is an invasive, non-surgical procedure. A coronary angiogram is a specialized xray procedure that is done as part of a cardiac catheterization. A cardiac catheterization and a coronary angiogram are done to study the structure of the arteries that bring blood to the heart muscle and to evaluate the function of the main pumping chamber of the heart. During a cardiac catheterization, the cardiologist inserts a small hollow tube (catheter) into an artery or vein and then advances it into the heart. The cardiologist injects contrast (x-ray dye) through the catheter to outline the arteries to show any blockages or narrowings that may exist within them. Myocardial Perfusion Imaging (MPI) Stress Testing (Persantine Thallium)These tests help identify blood flow problems to your heart. Small amounts of a radioactive material are injected into your bloodstream through your IV. Special cameras can detect the radioactive material as it flows through your heart.

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MEDICATION BETA-Adrenergic Blocking Agent-to slow the heart rate and to reduce the chance of abnormal heart rhythms developing Anticoagulant-helps prevent the formation of blood clots. Angiotensin Converting Enzyme Inhibitor- is also used to treat a disorder of the ventricles (the lower chambers of the heart that allow blood to flow out of the heart) Corticosteroid- decreasing inflammation and reducing the activity of the immune system Platelet Aggregation Inhibitors-to reduce the stickiness of platelets in the blood, which helps to prevent blood clots forming

MEDICATION Carvedilol 125 mg 1 tab BID(GIVEN)

Enoxparin 0.6cc sq q 12H(GIVEN)

Enapril 10mg 1tab OD(GIVEN)

Hydrocortisone 200mg IVTT(GIVEN)

Aspirin 80mg 1 tab PO(GIVEN) Clopidogrel 75mg 1tab PO(GIVEN)

Statins-used along with diet, exercise, and Atrovastatin 80mg 1tab q HS(GIVEN) weight loss to reduce the risk of heart attack and stroke and to decrease the chance that heart surgery will be needed in people who have heart disease or who are at risk of developing heart disease. Atorvastatin is also used to decrease the amount of cholesterol (a fat-like substance) and other fatty substances in the blood Hyperosmotic agent-Produces increased Lactulose 30cc q HS PO(GIVEN) osmotic pressure within colon and acidifies its contents, resulting in increased stool water content and stool softening. Causes migration of ammonia from blood into colon, where it is converted to ammonium ion and expelled through laxative action.

DIET Low Salt Diet- People with heart failure can improve their symptoms by reducing the amount of salt (sodium) in their diet. Sodium is a mineral found in many foods. Eating too much salt causes the body to keep or retain too much water, worsening the fluid build-up associated with heart failure Low Fat Diet- Limiting how much saturated and trans fats you eat is an important step to reduce your blood cholesterol and lower your risk of coronary artery disease. A high blood cholesterol level can lead to a buildup of plaques in your arteries, called atherosclerosis, which can increase your risk of heart attack and stroke

DIET Low Salt Diet includes bread, cereals, pasta rice potatoes, dried peas and beans, meats and protein, fruits and vegetables

Low Fat Diet includes whole wheat pasta, egg whites, tuna, crab, shrimp, fruits and vegetables