His boots were enormous, and caked with the dirt of his work. His clothes, brought up by an ER tech in a clear plastic bag, included a construction helmet and vest. Crushing chest pain and shortness of breath had bought him this sunny day off of work and a direct ticket to the cardiac catheterization lab at Mount Sinai Beth Israel. A “DASH,” we called him, the recipient of the quick, protocol-driven work of our “Direct Angioplasty Saves Hearts” initiative for the intervention of acute ST elevation myocardial infarctions, or heart attacks.
When he finally arrived in the coronary care unit where I was working, he was all smiles: a strange picture of calm after a life-altering event. Almost unaware of the fact that his heart had suffered a huge attack just hours before, his life saved by the quick, skilled insertion of a drug-eluting stent (a small mesh tube coated with medicine) into one of his heart’s major arteries, he joked. “I drank too much Saturday night,” he chuckled. “Guess I shouldn’t have had so much.”
After a Life Saved, the Work Begins
The longer I work in cardiac services, the more I see people with this casual attitude after serious brushes with death. We have become so skilled at our jobs; getting a patient with signs of a major heart attack into the hospital, on the intervention table, with a balloon inflated in the problem artery in no time, we literally save lives. Under the DASH program, with the American Heart Association as our guide, each patient is closely tracked, each action in the process analyzed for future success. But what about educating the patient about necessary post-intervention lifestyle changes?
I wanted to chuckle with my handsome, newly saved patient. “Of course, you should drink less and eat less. But you have a new heart now, sir! Your arteries are brand new. Go! Live life!” This is certainly what he longed to hear.
Instead, I took a different approach: I told him the truth. While his condition was likely hereditary, his future was in his hands. With a new drug-eluting stent opening his artery, he now had to work to preserve its ability to maintain blood flow to the heart. Anticoagulation therapy to prevent blood clots must be adhered to strictly, under a cardiologist’s guidance. Cardio-protective drugs, such as beta blockers, would be needed, too.
I spared him no detail; these drugs often come with side effects he likely wouldn’t love, and require vigilance and assessment. Watching for bleeding risk or signs of hypotension (low blood pressure) would pose daily tasks for this new patient. I also urged him to reconsider his diet and drinking habits, tailoring them towards promotion of cardiac health. In other words, consume less fat, less salt, less booze.
Education Is Integral to Recovery
While the life-saving interventions of the DASH protocol and the cardiac cath lab are irreplaceable, we often forget that the nursing education component is equally important. Our patients might have newly improved hearts with arteries clean of plaque and open for flowing blood, but their stents and their interventions will only last so long without appropriate lifestyle modifications. Our teaching, while initially met with frowns, might keep smiles on our patients’ faces—and in their hearts—for years to come.
Amanda Anderson, RN, BSN, CCRN is a seven-year ICU nurse who has spent most of her bedside years in medical intensive care units, but is now floating throughout critical care units at Mount Sinai Beth Israel. She studies nursing administration at the Hunter-Bellevue School of Nursing, where she also codirects The Nurses Writing Project. You can find her on Twitter @12hourRN, on her personal blog, “This Nurse Wonders,” or zipping around Manhattan on her trusty bike.
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