guidelines for BP

The best way to avoid hypotension following NTG with CP is to get a 12-lead first. While the majority of MI's affect the left ventricle, if an MI affects the right ventricle then NTG is contraindicated and will typically cause much more severe hypotension than in a LV MI. RV MI's typically need an aggressive increase in preload, while NTG reduces preload.

When NTG is indicated the usual rule is Nursing judgement.

The best way to avoid hypotension following NTG with CP is to get a 12-lead first. While the majority of MI's affect the left ventricle, if an MI affects the right ventricle then NTG is contraindicated and will typically cause much more severe hypotension than in a LV MI. RV MI's typically need an aggressive increase in preload, while NTG reduces preload.

When NTG is indicated the usual rule is Nursing judgement.

The best way to avoid hypotension following NTG with CP is to get a 12-lead first. While the majority of MI's affect the left ventricle, if an MI affects the right ventricle then NTG is contraindicated and will typically cause much more severe hypotension than in a LV MI. RV MI's typically need an aggressive increase in preload, while NTG reduces preload.

When NTG is indicated the usual rule is Nursing judgement.

Love the info here. I'm curious- do you typically get an EKG and interpret it before you treat? I'm definitely not experienced enough in reading EKG changes to differentiate anything but STEMI vs NSTEMI at this point. We generally give the first SLN then get the EKG btwn doses, get the MD to the floor, etc.

Hopefully if your patient is having CP you have or have had some place a call to the MD. In my previous experience on the Cardiac floor we have a Chest Pain Order Set that already had guidelines set in place. You might need to get in touch with your hospitals educator.

I just want to thank all of you for sharing on these threads. As a new nurse I've learned so much just by reading these! I realize everything needs to be adjusted to policy protocol, physician preference and orders as well as the patients symptoms, but these real world scenarios really make me think and things just make more sense.

always always obtain a 12 lead ekg with any CP FIRST. i would not blindly treat that CP without an EKG with active chest pain and post treatment to compare. as another poster said the patient could be having a right sided MI in which case you would not treat with nitro d/t preload reduction which i am oversimplifying. not to mention a whole host of issues and comorbid conditions the cardiac patient may have that would preclude adminstering nitroglycerine simply for cp.

you may also find that SL TNG can promote wild swings in sbp where as IV TNG does not produce such wild swings

also i wouldnt start TNG with a sbp 90 or depending on what is declaring itself, less than 100. where are you going with vasodilators with a SBP starting point of 90? shock?

The best way to avoid hypotension following NTG with CP is to get a 12-lead first. While the majority of MI's affect the left ventricle, if an MI affects the right ventricle then NTG is contraindicated and will typically cause much more severe hypotension than in a LV MI. RV MI's typically need an aggressive increase in preload, while NTG reduces preload.

When NTG is indicated the usual rule is Nursing judgement.

I'm new to cardiac and had a quick question and am wondering by the EKG, how could you determine if the CP is associated with the left or right ventricle?