🫀 Physiological Adaptation · Lesson 5 of 10 · 8 min

MI and Heart Failure: Minutes and Pounds

⏳ For a heart attack, the clock is minutes: 12-lead within 10, balloon within 90. For heart failure, the clock is pounds: 2 or 3 overnight means call. The exam checks both clocks.

💡 Key idea

MI: ECG in 10 minutes, aspirin, nitro, PCI within 90 minutes, watch for arrhythmias. Heart failure: left is lungs, right is body; daily weights; 2 to 3 pounds overnight means call.

🧠 Why it matters

MYOCARDIAL INFARCTION: crushing chest pain or pressure unrelieved by rest or nitroglycerin, radiating to the arm, jaw or back, with diaphoresis, nausea and dyspnea; women, older adults and diabetics may have fatigue, indigestion or shortness of breath instead. Obtain a 12-lead ECG within 10 minutes of arrival and TROPONIN levels. Give chewed ASPIRIN, nitroglycerin, oxygen if saturation is below 90%, and morphine for pain not relieved by nitrates; for ST-elevation MI the goal is percutaneous coronary intervention within 90 minutes or fibrinolytics within 30 minutes of arrival when no cath lab is available. Monitor for arrhythmias, the leading cause of early death, and for heart failure and cardiogenic shock. HEART FAILURE: LEFT-sided failure backs up into the lungs with crackles, dyspnea, orthopnea, frothy pink sputum and a cough; RIGHT-sided failure backs up into the body with jugular venous distention, peripheral edema, hepatomegaly and weight gain. Daily WEIGHTS at the same time each morning; a gain of 2 to 3 pounds in a day or 5 pounds in a week means call the provider. Teach sodium restriction, fluid limits as ordered, and medications: sacubitril-valsartan (or an ACE inhibitor or ARB); a beta blocker; spironolactone (an MRA); an SGLT2 inhibitor; diuretics for fluid; and sometimes digoxin. BNP rises with failure. Acute PULMONARY EDEMA: sit upright with the legs dependent, high-flow oxygen, IV furosemide, nitrates and morphine as ordered.

🏥 In the real world

⚖️ A client with heart failure is discharged with a scale and a rule. Four days later she weighs 3.5 pounds more than the day before and her ankles are puffy, so she calls the clinic instead of waiting for breathlessness. A diuretic adjustment keeps her out of the hospital. The weight rule works because fluid shows up on the scale a day or two before it shows up in the lungs.

📌 Takeaways

ECG within 10 minutes; aspirin, nitro, oxygen if under 90%, PCI within 90 minutes
Left failure: crackles and dyspnea; right failure: edema and JVD
Daily weight: 2 to 3 lb in a day or 5 lb in a week means call

📖 Terms in this lesson

Left-sided heart failure: Failure that backs blood up into the lungs, causing crackles, dyspnea, orthopnea and frothy sputum.

Right-sided heart failure: Failure that backs blood up into the body, causing jugular venous distention, edema and liver enlargement.

MONA (heart attack drugs): Morphine, Oxygen, Nitroglycerin, Aspirin: the classic recall list for a suspected heart attack; today aspirin comes first, oxygen only below 90% saturation, and morphine only if nitrates fail.

LEFT = LUNGS, RIGHT = REST (heart failure sides): Left-sided failure backs up into the Lungs (crackles, dyspnea, frothy sputum) and Right-sided failure into the Rest of the body (edema, neck veins, liver): the heart failure symptom sorter.

Sacubitril-valsartan: A heart failure combination that cuts deaths and hospital stays; never give it within 36 hours of an ACE inhibitor or to anyone who had angioedema on an ACE inhibitor or ARB, watch blood pressure, potassium and creatinine, and stop it in pregnancy.

Antiplatelets (aspirin, clopidogrel): Keep platelets from clumping after heart attack, stroke or a stent; both cause bleeding and are usually stopped 5 to 7 days before surgery per order, aspirin is never given to children with viral illness (Reye's syndrome), and omeprazole weakens clopidogrel.

✅ Test yourself

A client with heart failure reports gaining 3 pounds since yesterday morning and feeling more short of breath. What should the nurse advise?

Increase fluid intake to flush out the sodium
Contact the provider today
Wait a week and weigh again
Skip today's diuretic to see if it improves

Answer: B · Contact the provider today

A 2 to 3 pound overnight gain indicates fluid accumulation and requires prompt medication adjustment.

A client arrives with chest pain radiating to the left arm and diaphoresis. Which action is the priority within the first 10 minutes?

Obtain a detailed family history
Schedule an echocardiogram
Obtain a 12-lead ECG
Begin discharge teaching

Answer: C · Obtain a 12-lead ECG

The 12-lead ECG identifies ST elevation and drives the time-critical reperfusion decision.

Which findings indicate LEFT-sided heart failure?

Jugular venous distention and ankle edema
Hepatomegaly and ascites
Weight gain and abdominal distention
Crackles, orthopnea and frothy sputum

Answer: D · Crackles, orthopnea and frothy sputum

The left ventricle backs blood into the lungs; the right ventricle backs it into the systemic circulation.

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