It was a few days before my birthday that I received a phone call that changed my family’s life. I was going to be turning 26, I was newly married, and starting a brand new, exciting job. For those of you who don’t know my background, I have been a cardiac nurse for 3 years. I started working on an open-heart step down unit as an extern in nursing school, and transitioned to a Registered Nurse on the same floor. (Shout out to my 3-Northers!!! LOVE YA! ) It was there that my love for cardiac nursing came about. I wanted to learn everything I could about cardiology! Starting on this type of unit really equipped me to go anywhere after that! The heart is a fascinating organ and controls everything in the body! So here I was, 3 years from my start on this open heart step down unit, starting my job as a float nurse, and specializing on cardiac floors. I was going through my last days of orientation at my new job when I received a phone call from my mom as I was driving home. “ Kelsey, Daddy is in the hospital, he had a heart attack.” Everything in my body stopped for a few seconds. My parents were invincible in my eyes. Nothing can happen to them! I pulled the car over, bawled my eyes out, and asked all of the questions I could.
My Dad had a STEMI. For those of you not super familiar with that term, it stands for “ST segment elevation myocardial infarction.” Our body’s natural rhythm consists of certain normal wave forms. We have T waves, P waves, and a QRS interval. Below is an example of a normal sinus rhythm wave form, and a STEMI.
When patient get admitted with a STEMI or NSTEMI ( Non STEMI), that will determine their care plan. They will do an EKG to confirm and if time allows, they draw labs to look at a protein called troponin. This indicates if there is dying heart tissue ( aka, blood flow ain’t getting to the heart, muscle tissue is dying, and we need to intervene STAT!) The reason STEMI’s are so emergent is because an ST elevation indicates there is a complete blockage of blood flow in some area of the heart. It is a deadly type of heart attack because as your heart muscle dies from not receiving blood flow, it can no longer move and PUMP blood the way it did because of the dying muscle. That can cause decreased cardiac output and if it goes blocked long enough, your whole heart stops, resulting in cardiac death. Our heart is a muscle that is constantly pumping to get blood to the body and back to the heart. If cardiac muscle dies because a coronary artery has a blockage, the area that was effected can become paralyzed (or dead) and can no longer do its job of pumping (moving) in that area. It is important that all muscle in the heart can move, because that is how blood gets pumped out to all of the organs in the body!
So as a nurse, when you hear a patient has a STEMI, or the monitor room calls you and says “ HEY, YOUR PATIENT HAS ST ELEVATION NOW”, you know that things get real!
As a nurse, when a patient starts having chest pain or their rhythm changes, you want to do a few things:
Get a STAT EKG
Have someone call the doctor.
STAT cardiac Enzymes.
You’ll want to get a set of vitals on your patient.
You can put some o2 on your patient, can’t hurt.
And most likely if it is a true STEMI, they will be super symptomatic and you’ll be preparing to get this patient to the CATH lab STAT, and following any last minute orders ( give Nitro, morphine, etc….)
Here’s the deal: Symptoms of this type of heart attack can occur as long as a month before the initial attack. The reason for this is that blood is flowing through a TINY space in your heart. If you were to exercise days before having one of these cardiac events, you would most likely be more short of breath and diaphoretic (sweaty) than normal because your heart and other organs are demanding more oxygen than when you are just resting. If there is a blockage, your heart is not going to get the oxygen it needs and will try to increase blood pressure to get the oxygen back to the heart! Chest pains are also common! Lack of oxygen to heart = chest pain (ischemia).Here are some common symptoms to pay attention to:
Chest pain (most commonly described as a sensation of tightness, pressure, and or squeezing – patients often say it feels like “an elephant is sitting on their chest”)
Heart burn (pain can often mimic heart burn as it radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, and back)
Shortness of breath
Loss of consciousness
***Women can have unique symptoms like: Abdominal pain, Fatigue, Tingling in fingertips, and weakness. They may not have Chest Pain!
My Dad was out running the morning he had his heart attack. He came home and started having really bad chest pain and sweating perfusely. He thought it was bad reflux. He DROVE himself ( Yes, he drove his prideful, manly, self to the ER! CALL 911 PEOPLE! ), and when he walked up to the counter, he was pale, diaphoretic, and weak. They IMMEDIATELY knew what was going on and rushed him to the Cardiac Catheterization Lab. This is where they will put in cardiac stents, also know as PCI’s ( Percutaneous Cardiac Interventions). The Doctor will go up through an artery in your wrist or groin with a wire, and advance a cardiac stent up the wire, blowing it up in the artery. It looks like a tiny chinese finger trap. They open up the blockage in your artery, reestablishing blood flow. It literally pushes that blockage up against the artery’s wall, and it becomes patent. Because of this stretching of the vessel, it’s not uncommon for patient to experience little chest pains hours or a couple days after the intervention. MAJOR, symptomatic chest pain warrants a follow up with the Doctor ASAP. That could mean the stent closed back up. These PCI’s are done everyday where I work, but when I step back and think about it, it’s absolutely amazing! And 5 stents later, it saved my dad’s life.
These pictures above show how a stent is placed in the artery and what the before and after look like with an x-ray on the artery. You can see the circled area in the first picture where the artery looks pinched. The second circled area is where the stent was put it. There is now a dark cylinder area where the artery was opened up and the darkness indicates blood flow! SO COOL!
My dad had a few setbacks with his event. He did go into an abnormal rhythm where they had to shock his heart a few times. This led to Atrial Fibrillation afterwards. After all of his interventions, they kept him on an anit-arrhythmic medication called Amiodorone ( I think the name sounds like a transformer…just funny to me….”And the archnemisis AMI-O-DORONEEEE” ). It’s very effective at helping the heart maintain a normal rhythm. Patients will sometimes go home on it for a few months after, but they don’t stay on it longterm, as it can have negative effects on the thyroid. My Dad has remained in Normal Sinus Rhythm since.
When my Dad left the hospital after his recovery, he was on some important medications. I am not one for synthetic drugs, as much of my lifestyle is as natural as possible, but these medications are a must when it comes to cardiac patients. I think medication has its time and place, but it’s when patients start developing what is called polypharmacy, things can get rough. Look it up;).
Amiodorone- This is a medication that helps convert and keep your heart in a normal sinus rhythm. Super important because many post-STEMI patients are at risk for rhythm abnormalities such as atrial fibrillation ( this is when your heart’s atrium quivers instead of pumping a normal “lub-dub” sound. This can lead to blood clot formation in your heart. That is nothing but trouble!)
Metoprolol (Lopressor)- This drug is known as a “Beta Blocker.” It allows the heart to relax and beat more slowly thereby reducing the amount of blood that the heart must pump. Over time, this action improves the pumping mechanism of the heart. This will also help improve the ejection fraction of your heart. This can be affected when you have an MI, especially a STEMI. Your ejection fraction is the measurement of the percentage of blood leaving your heart each time it contracts. A normal EF is 55-70%. Heart Failure is considered less than 35%. Just FYI 🙂
Cozaar ( Losartan) – This is known as an “ ARB” in the cardiac world. Post-heart attack, patients will most likely be started on an ACE Inhibitor or an ARB if their blood pressure and kidney’s can tolerate it. The way this drug works is that it blocks the effect of a chemical called angiotensin II which is made in your bloodstream. Angiotensin II causes your blood vessels to narrow and also leads to the production of another chemical called aldosterone, which increases the amount of fluid in your blood (which can increase blood pressure and cause fluid build up in body “edema”). By preventing the action of angiotensin II, Losartan reduces how much work your heart has to do and lowers your blood pressure. It also has a protective effect on your kidneys and can slow heart remodeling after a heart attack. This helps reduce the amount of mass your heart has. The less mass, the easier to pump, and less risk of heart failure developing. Most patients will be started on an ACE- Inhibitor. But if you’re like my dad, and experience a bad cough from the ACE ( the most common side effect), they will switch you to an ARB.
Aspirin- this is a mild anti-platele that all post MI (myocardial infarction) patients will be on.
Effient (Prasugrel)- This is an anti-platelet medication. The purpose is to prevent platelets from sticking to where the stents are, as they are susceptible to clotting due to a new foreign object placed in the arteries. Platelets can stick to the stents, allowing clots to form, which can cause another blockage in the heart! Patients will be on an anti-platelet for at least a year until smooth muscle tissue grows over the stents in the arteries.
PPI’s- Nexium or Protonix- I am unsure about this medication. I’ve been told it is used to prevent ulcers from all of the acidic blood thinners, Effeint and Aspirin, but I’ve met patients who have been on those type of medications for 10+ years without one of these and have had no issues. My Dad is going to discuss this with his Cardiologist at his next appointment.
Atorvastatin (Lipitor)- Atorvastatin is in a group of drugs called HMG CoA reductase inhibitors, or “statins.” Atorvastatin reduces levels of “bad” cholesterol (low-density lipoprotein, or LDL) and triglycerides in the blood, while increasing levels of “good” cholesterol (high-density lipoprotein, or HDL). People with high cholesterol are at a higher risk for an MI. This drug sounds great in theory, but it can cause issues with the liver and is known to cause other side effects (cramping) that make people switch to another statin or come off. If you or someone you know is put on this medication, make sure they have their liver enzymes monitored!! Side note: My dad’s cholesterol was never bad at his annual check ups before the MI! You can have micro-cholesterol that isn’t necessarily detected in the blood, that can contribute to build up in you arteries! So just because you have good cholesterol, don’t continue eating cheeseburgers and fries! It’s building up behind the scenes! Love your body with what you eat!
So these are most of the common types of medications people will be put on! There are different classes and names that you or someone else may be on, but these correlate with my Dad’s regiment! Myself, along with his medical professionals, are staying on top of it all! We stopped his Amiodorone a couple months ago. We are now watching his thyroid labs because there was slight elevation possibly from the amidorone, along with his liver enzymes from the Atorvastatin. If there was a natural remedy that was PROVEN for all of these drug functions, we would be all over it. However, when it comes to the heart, and my Dad’s heart, him nor myself are taking a chance with this! He is doing amazing and has changed his lifestyle in the way that every cardiac nurse DREAMS their patients would!
He no longer drinks caffeine. For my dad, that is unbelievable! Since I can remember my daddy, he’s had a Pepsi or a cup of coffee in his hand! Coffee with lots of trans-fatty creamer and sugar! He now drinks decaf and makes his own Cashew milk creamer! SERIOUSLY?!? GO DAD!
The man bikes 5 miles every morning and walks with my mom. He is my hero. He takes his fish oil ( which helps improve cholesterol in all ways – increasing HDL and also improving brain health). He also has his daily vitamin routine.
He has changed his diet greatly. Cutting out bad cheeses ( which are high in cholesterol). He eats grilled chicken and turkey. No more ham, bacon, or sausage. He has loaded up on healthy grains, good fats, and loves to find new ways to make his old habits healthy.
I am SOOOOOOO Proud of this man, and I am so thankful for his life! And I am VERY thankful for modern day medical intervention. My dad is alive because of it!!!!
If you or anyone you know has had a heart attack, or is at risk for one, please consider your diet and lifestyle changes. Educate yourself with risk factors and symptoms!
-High Blood Pressure
-Middle Age 40-55 years old
My Grandfather on my Dad’s side (his dad) had two heart attacks. My Dad had the family history. Other than that, he was slightly pre-hypertensive, and liked to eat red meat. Those are risk factors, but I would have considered him very healthy! I really feel his event had a lot to do with genetic predisposition. We could have lost my dad that day! Going through the whole experience at his bedside put me in a position that I have never been in before…..on the patient side. It has given me perspective and makes me want to be more of an educator and more empathetic for these patients! It is so scary and so overwhelming! I hope this is helpful to you non-cardiac nurses and curious friends!
My Dad is healthy and amazing. We are doing all we can to prevent another event, and he is such a champ! SO proud of him!! As always, your heart is mine. Lets keep them healthy!!!