Following LHC (left heart cath)

Following LHC procedure: (example A&P)

Assessment:

  • Acute Coronary Syndrome/NSTEMI s/p LHC with PCI and DES to OM and Diagonal Arteries.
  • H/O CAD with h/o LHC and RCA stent in 2012 and residual circ disease
  • Uncontrolled DM 2
  • HTN
  • Hyperlipidemia
  • Ongoing Tobacco Abuse
  • Metabolic acidosis
  • Chronic low BP

Plan:

  • Admit to PCU
  • Strict bed rest x 4 hours (only need bed rest for femoral approach, no bed rest needed for radial approach)
  • Continue to monitor closely and do serial groin checks.
  • Continue Integrilin x 18 hours [Integrilin: Eptifibatide = an antiplatelet drug of the glycoprotein IIb/IIIa inhibitor class, started during LHC if patient has high clot burden]
    • Continue Integrilin only if started in the cath lab. Do NOT start after cath if not already on during cath.
  • Continue Aspirin 81 mg PO qd indefinitely. Continue Clopidogrel 75mg Po qd for 1 year following placement of DES. Will start Clopidogrel tomorrow as he received it today during LHC.
    • If does not tolerate Plavix: Will start on Effient.
  • Start on Atorvastatin 40mg PO qd.
  • Morphine IV PRN pain with holding parameters.
  • Continue home antihypertensive medications: Lisinopril 40 mg daily and Lopressor 25 mg BID with holding parameters.
  • Lantus and Accuchecks with SSI for DMII. Hold Metformin both before the LHC and 72 hours after LHC.
  • EKG and Troponin prn for chest pain
  • Cardiology consulted for further evaluation and follow up after LHC.
  • Counselled on smoking cessation.
  • CBC, CMP, Magnesium.
  • Continue oxycodone for lower back pain

Code Status: Full Code

DVT prophylaxis:

  1. Start prophylactic Lovenox tomorrow.
  2. OR: If on Integrelin drip, continue for 18 hours post-LHC. Start heparin after the Integrelin drip is over in 18 hours.

At discharge:

– Do not take Apixaban for 3 days following LHC. Restart after 3 days.

– Start Plavix daily. [Change Omeprazole to Protonix – less interaction with Plavix.]

– Continue taking Aspirin 81mg daily for the next month and then stop Aspirin (ex: if patient has thrombocytopenia already).

– Stop taking Naproxen and do not start taking any other NSAID medications (Ibuprofen, Aleve, etc).

– Make sure that the patient is on high-intensity statin at discharge (Atorvastatin 40-80mg PO qd).

– Follow up in Cardiology clinic in 2-3 weeks.

– No intense physical exertion for 5-7 days.

– No hot baths/ hot tubs for 5 days.

– No driving for 48 hours.

– No lifting weights more than 20 lbs for 14 days.

– If any worsening chest pain or SOB, call 911.

 

 

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