Heart attack (myocardial infarct) medications | NCLEX-RN | Khan Academy
Heart attack (myocardial infarct) medications | NCLEX-RN | Khan Academy
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Content
1.549 -> - [voiceover] The main idea in
treating myocardial infarcts
4.343 -> is to limit the damage
that happens to your heart,
7.315 -> and to minimize complications
that might crop up.
10.426 -> The treatment has to address the clot
12.794 -> that caused the myocardial
infarct in the first place.
15.511 -> And it has to restore the balance
17.369 -> between the myocardial
oxygen supply and demand.
20.944 -> So there are some treatment aspects
22.57 -> that are common to all of the types
24.427 -> of acute coronary syndromes.
25.983 -> But there's some really
important differences
27.492 -> in the approach to patients
who present with a STEMI,
30.186 -> or an ST elevation myocardial infarct;
32.879 -> compared to unstable angina and N STEMI,
35.874 -> non-st elevation myocardial infarct.
38.568 -> And we'll talk about those.
39.682 -> Unstable angina and N STEMI's
41.516 -> they're usually treated in the same way.
43.56 -> Whereas STEMI's are treated
a little bit differently
45.882 -> because they're more serious.
47.53 -> So what happens?
48.436 -> Well any patient who comes to a hospital
50.525 -> with a suspected heart attack,
52.569 -> with a suspected myocardial infarct,
54.542 -> will first be admitted to
an intensive care setting.
57.839 -> They would be under
continuous ECG monitoring
61.183 -> for arrhythmias, or
abnormal heart rhythms.
64.572 -> Remember the ECG would also
give a really good idea
67.057 -> of what type of heart
attack they might have had.
69.379 -> They'd be made to lie down in bed
71.515 -> to prevent their heart
from working to hard.
74.046 -> Thus, minimizing their
heart muscles oxygen demand.
77.738 -> They might be given supplemental oxygen,
80.199 -> if it turned out that they
weren't carrying enough
82.544 -> oxygen in their blood stream.
84.425 -> And they might be given morphine
85.772 -> and that's to reduce
the amount of chest pain
87.699 -> that they're feeling.
88.535 -> And to also reduce the amount of anxiety
91.135 -> that they might be feeling.
92.529 -> And hopefully by doing that,
93.62 -> by reducing their anxiety
they'd reduce their heart rate
96.87 -> and even further reduce
the amount of oxygen
99.076 -> that their heart needed.
100.771 -> Really importantly, they'd
be given aspirin too.
103.465 -> And the aspirin would
reduce the development
105.67 -> of the clot that might be
causing their symptoms,
107.853 -> that might be causing
their myocardial infarct.
110.152 -> This aspirin is actually
one of the most important
112.427 -> interventions in reducing
mortality in patients
115.608 -> with all forms of acute coronary syndrome.
119.319 -> Okay, so all that stuff happens right away
121.32 -> on an immediate basis.
123.108 -> Then we have to think
about sort of getting rid
125.708 -> of that clot that caused
their heart attack.
128.401 -> And allowing blood to
flow back into that area
130.676 -> that was deprived of blood.
133.391 -> So getting rid of that clot
and allowing blood back
135.832 -> into that part of the heart
is called reperfusion.
139.129 -> And that's the next goal.
140.662 -> If a patient comes in and the ECG trace
143.378 -> has determined that they have a STEMI,
145.63 -> an ST elevation myocardial infarct
148.068 -> and they presented to the hospital
149.833 -> within about two hours of
the onset of their symptoms.
153.13 -> They might be given a medication
to break down their clot,
156.172 -> in a process called
thrombolysis, or thrombolysis.
159.33 -> Thrombo refers to the blood clot
161.605 -> and lysis refers to break down.
163.834 -> This is actually what's being referred
165.382 -> to when you hear of clot busters.
167.317 -> Unfortunately, no
relation to Ghostbusters.
170.103 -> So if this mediation's given early enough,
172.657 -> there's a really high chance
of restoring blood flow
175.351 -> to the damaged part of the heart.
176.837 -> And that actually really
reduces the tissue damage
179.762 -> that the heart would experience.
181.782 -> Again, just to reiterate this is only
184.313 -> for patients with STEMI's, not
unstable angina or N STEMI's.
189.607 -> And that's because the type of clots
191.094 -> that are being busted
up with clot busters,
192.811 -> they're only found in
STEMI's and not in N STEMI's.
196.689 -> So everything that we've
talked is really part
198.895 -> of the acute management of someone
200.706 -> who presents with an
acute coronary syndrome.
203.771 -> So all this stuff will happen
in the hospital right away.
206.534 -> Then the patient will
be put on medications
208.763 -> at the hospital that they'll
then have to continue
211.456 -> for the rest of their life.
212.919 -> And the reason for this is because
214.243 -> taking these medications
for the rest of their lives,
217.354 -> this has been shown in clinical trials
219.536 -> to reduce mortality, so
that's the rate of death
222.23 -> attributed to having had
a previous heart attack.
225.504 -> Among other positive affects,
they've also been shown
228.267 -> to reduce the chance of you
having another heart attack.
232.26 -> So again, these are
medications that you'll start
234.443 -> in hospital after the
sort of acute management.
237.276 -> And then you'll need to
be on them indefinitely.
239.853 -> So what are these drugs?
241.293 -> Well, there's drugs that try to restore
244.288 -> that oxygen supply and demand balance.
247.26 -> So drugs like beta
blockers, beta blockers work
250.487 -> by making the heart beat slower,
252.461 -> so fewer beats per minute.
254.202 -> And it also makes the heart
beat with a reduced force.
257.291 -> So over all this reduces
the heart's oxygen demand,
260.053 -> because if the muscles not working as hard
262.445 -> it needs less oxygen.
264.326 -> Another group of drugs you
might get are nitrates.
267.46 -> Nitrates are vasodilators,
269.364 -> so they open up your blood vessels.
271.733 -> They dilate your blood vessels
to improve your blood flow.
275.613 -> You'd also be given more medications
277.143 -> to prevent the development of more clots
279.534 -> that could block off
your coronary vessels.
282.019 -> So you're already on
aspirin, but you might also
283.923 -> be given one called heparin or warfarin.
286.848 -> And what these do is they
prevent your clotting cascade
289.472 -> from happening as easily.
290.865 -> So they slow down the growth of,
292.374 -> first of all the clot
that might have caused
294.186 -> your myocardial infarct,
295.579 -> and second any further
clots that you might develop
297.692 -> down the track.
299.461 -> You'd probably be given a statin.
300.989 -> Statin's reduce your
blood cholesterol level.
303.589 -> And so they decrease progression
305.215 -> of atherosclerotic buildup
in your coronary arteries.
308.465 -> Remember plaques are
filled with cholesterol,
310.714 -> so you'd probably be given a statin
311.925 -> to take indefinitely.
313.481 -> Finally, you might be
given an ace inhibitor.
316.44 -> Ace inhibitor's reduce blood pressure
318.542 -> and actually studies have shown
320.052 -> that ace inhibitors can reduce
negative structural changes
323.976 -> that can happen in your heart
after myocardial infarct.
327.528 -> So those are the major, sort of treatments
329.548 -> with medications that you get
330.988 -> after having a myocardial infarct.
Source: https://www.youtube.com/watch?v=Pfg9FY1Fguc