Master Myocardial Infarction Interventions with Picmonic for Medicine

Aspirin, commonly abbreviated ASA, decreases platelet aggregation and, to a lesser extent, decreases vasoconstriction. It is typically given as 325 mg by mouth. It is important to know that you should give non-enterically coated chewable “baby” aspirin, which is 81 mg. If using enterically coated aspirin in an emergent situation, it should be crushed or chewed.

Nitroglycerin may be given sublingually (tablet or spray) and, if needed, as an IV infusion. It causes venous dilation, which decreases preload and lowers the heart’s oxygen demand. Check for contraindications before giving: avoid nitrates if the patient is hypotensive, has a right-ventricular infarction (preload dependent), or has taken phosphodiesterase-5 inhibitors such as sildenafil (Viagra) in the past 24–48 hours, because severe hypotension can occur.

Oxygen increases the percentage of oxygen available to the alveoli. Supplemental oxygen is only indicated if the patient’s SpO₂ is < 90 % or they are in respiratory distress. Routine high-flow oxygen is no longer recommended because it can cause coronary vasoconstriction and may worsen outcomes when given unnecessarily.

Thrombolytic drugs such as tPA (alteplase, reteplase) can dissolve clots in the coronary arteries. They are used only when rapid percutaneous coronary intervention (PCI) isn’t available, and are most effective if given within 6–12 hours of symptom onset (ideally ≤6 hours). Make sure to screen carefully for contraindications such as prior intracranial bleeding, recent major surgery or trauma, and uncontrolled hypertension.

Also called “Cardiac Cath” or “Coronary Angiography,” this procedure involves placing a long tube through an artery into the coronary arteries to evaluate the extent of coronary artery disease blockages. This procedure will indicate the need for further interventions such as stent placement or CABG.

Stents are tubular mesh-like structures placed inside blood vessels to increase blood flow. They are placed via cardiac catheterization or PTCA through large arteries. Stents are coated with medications like clopidogrel (Plavix) to reduce clots from forming on the mesh.

Angioplasty, otherwise referred to as percutaneous transluminal angioplasty (PTCA), is a minimally invasive procedure that is used for stent placement through a large artery like the femoral. A stent is introduced over a balloon which is inflated in place pressing the stent into the walls of the vessel increasing the lumen size.

Coronary Artery Bypass Graft (CABG), commonly pronounced “cabbage,” is an invasive procedure that involves removing a vein, such as the saphenous vein from the leg, and creating an artificial graft for blood flow around blocked coronary arteries.

Educate the patient on the importance of reducing modifiable risk factors like smoking cessation, diet modifications, and the addition of exercise into the daily routine. A sedentary lifestyle is a major cause of coronary artery disease, which leads to MI. It is important to remember that modifiable risk factors may be different with patients of varying cultural backgrounds. Patients should also abstain from excessive alcohol use and attempt to decrease stress as both increase the risk for MI.

Commonly, patients will inquire about when they are able to resume sexual activity. Post myocardial infarction, they should be advised it is safe to engage in sexual activity once they are able to climb two flights of stairs successfully.