Cardiac question

Virgo_RN, BSN, RN · Dec 30, 2009

ACS=Acute Coronary Syndrome.

The heparin gtt was for the worsening CAD, to provide anticoagulation and prevent thrombosis in the coronary circulation. I'm guessing this patient probably had a date with the cath lab for a coronary angiogram with possible PCI.

Scenario: Pt. coming in with fatigue, weakness etc. Previous cardiac hx of CAD, CHF. Pt. had an EF of 65 8 months prior to this admission and on this one had fallen to 35%. Pt. was started on a heparin drip.
Here is my question...why is this patient on a heparin drip? I read her report and it said: pt. with a rapid decrease in EF due to rapid worsening of CAD. Plan was start patient on ACS protocol and continue to monitor.

ACS protcol where I worked involved anticoagulation and monitoring of cardiac enzymes. In the event of "positive" troponins, the patient would go to the cath lab. Your job, as the nurse, is to monitor the troponins and the patient's condition and notify the physician of any changes in either.

I have no idea what ACS protocol is. Another nurse told me it was anti-coagulation something (lol) Off going nurse, when I questioned the heparin said it is because her INR is not therapeutic. No hx of stents, replaced valves, PE, or previous anti-coag therapy (situations that I normally see pt.s need drips for).

ACS=Acute Coronary Syndrome.

We always monitored PTT with heparin gtts, not INR. INR is for Coumadin therapy in my neck of the woods. When you have a patient on a heparin gtt, you want the PTT to be in the therapeutic range. The PTT is monitored while the patient is on heparin not only to be certain they are getting the right amount of drug, but also to prevent them from getting too much. You should know your patient's PTT if they are on heparin, and what the desired range is.

Now if CAD is worsening wouldn't they be looking at angio, stents or even meds etc.? It makes sense to me that if your arteries are narrowing, thinner blood would = less problems, but I thought usually ASA or plavix was tx of choice.

IV anticoagulant medications such as heparin or Angiomax are the treatment of choice for someone who may be infarcting and needs acute intervention. Once the angioplasty/stent procedure is complete, they will be on ASA and Plavix. Typically they get a loading dose of Plavix prior to going to the cath lab, if they are not already on it.

Sugarcoma, RN · Dec 30, 2009

VirgoRN to the rescue once again!!!!

I can't believe I couldn't figure out acute coronary syndrome. I feel stupid. Now that makes sense. I didn't see any further interventions planned yet but the pt. had just been admitted that day. The off going nurse made it seem that was the only thing pt. was going to get and I just couldn't wrap my head around the fact that anti-coag would be her only tx.

Virgo_RN, BSN, RN · Dec 30, 2009

Don't feel stupid. How are you supposed to know this stuff if you've never been exposed to it before? What frightens me is that your cardiac floor is staffed with people that don't know this stuff! That's not your fault, and I am not attacking YOU, but in my opinion, this is not safe for the patients at all.

Virgo_RN, BSN, RN · Dec 30, 2009

Just want to add that they will probably want to go in and look to see if there are any lesions they can do anything about, like stenting or possibly CABG (last resort). If the CAD is diffuse, small vessel disease, they won't be able to place any stents and the person won't be a candidate for CABG, so they would opt for medical management, which involves tweaking the medication regimen. In the meantime, the person is on the heparin gtt.

mudd68 · Dec 30, 2009

Virgo RN, have you considered a career in education? Subject and rationale were very well explained here.

Virgo_RN, BSN, RN · Dec 31, 2009

No, but I do like to teach. I look forward to having enough experience to precept new nurses.