Myocardial infarction (MI), commonly known as a “heart attack,” occurs when there is inadequate perfusion to the myocardium due to a partial or complete blockage of blood and oxygen supply to the heart. Myocardial ischemia arises from this imbalance. Coronary artery disease is the primary culprit behind most heart attacks.
In emergency situations, oxygen deprivation initiates ischemia (reduced blood flow) at the cellular level. When the myocardial oxygen supply cannot meet the demand, it can lead to MI or cardiac death.
Besides coronary artery disease, other factors can precipitate MI, including:
- Vasospasm (sudden constriction of a coronary artery)
- Blood clots
- Electrolyte imbalances
- Trauma to the coronary arteries
Prolonged oxygen deprivation to the heart often manifests as chest pressure or discomfort, the most typical symptom. This pain may radiate to the neck, jaw, shoulder, or arm. Diagnostic evaluations, laboratory findings, and ECG alterations can confirm cardiac damage.
STEMI vs. NSTEMI
Myocardial infarctions are categorized into two primary types: ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). The key differentiator lies in their impact on the heart’s electrical activity, detectable via an electrocardiogram (ECG). In NSTEMI, unlike STEMI, there is no ST-segment elevation on the ECG because the coronary artery is only partially occluded. Despite the absence of ST-segment elevation, patients experiencing NSTEMI still exhibit heart attack symptoms.
Nursing Process
In managing suspected myocardial infarction, nurses play a crucial role in rapid assessment and intervention. The immediate nursing priority is to distinguish between chest pain indicative of angina and that of MI, as MIs necessitate immediate action to preserve cardiac tissue.
Upon arrival in the emergency room, patients with acute MI require immediate interventions to reduce ischemia, alleviate pain, and prevent circulatory collapse and shock. The MONA protocol (morphine, oxygen, nitrates, and aspirin) is typically initiated. Continuous cardiac monitoring is established, and intravenous (IV) access is secured for fluid and emergency medication administration. Further diagnostic tests and procedures, including cardiac catheterization or coronary artery bypass grafting (CABG), might be necessary.
Post-MI, nursing care extends to patient education and support for medication adherence, dietary and weight management, and lifestyle modifications to mitigate risk factors. Cardiac rehabilitation programs are often recommended for continued recovery after hospital discharge.
Nursing Assessment
The initial phase of nursing care is a comprehensive nursing assessment to gather physical, psychosocial, emotional, and diagnostic data. This section outlines subjective and objective data pertinent to myocardial infarction.
Review of Health History
1. Document General Symptoms. Patients may report a range of general symptoms, such as:
- Chest, back, shoulder, or jaw pain
- Palpitations
- Shortness of breath (dyspnea) at rest and during exertion
- Fatigue
- Sweating (diaphoresis)
- Nausea
- Fainting (syncope)
- Dizziness
2. Detailed Chest Pain Interview. Elicit a thorough description of the chest pain from the patient:
- Chest tightness
- Squeezing sensation
- Heaviness
- Burning
- Pain radiating to the arm or shoulder
- Pain onset during exertion or rest
- Jaw or abdominal pain during exertion or rest
- Intermittent or persistent pain patterns
- Pain duration exceeding 20 minutes
- Pain associated with physical activity
- Pain triggered by stress or emotional factors
3. Identify Risk Factors.
Non-modifiable risk factors:
- Gender and Age: MI incidence increases in men over 45 years and women over 50 years or post-menopause.
- Family history of ischemic heart disease: A family history of heart disease in a first-degree relative before age 55 elevates MI risk.
- Race/ethnicity: Black individuals face approximately double the MI risk compared to non-Black individuals.
Modifiable risk factors:
- Hypertension: Uncontrolled high blood pressure can lead to arterial stiffness and reduced oxygenated blood flow to the heart.
- Hyperlipidemia/hypercholesterolemia: Elevated low-density lipoprotein (LDL) cholesterol or decreased high-density lipoprotein (HDL) cholesterol levels increase MI risk.
- Diabetes or insulin resistance: Diabetes and insulin resistance contribute to arterial hardening and increased blood viscosity due to high glucose levels.
- Tobacco use: Both firsthand and secondhand smoke exposure are strongly linked to MI.
- Obesity: Obesity increases blood pressure as the body requires more blood circulation to supply oxygen and nutrients, placing extra strain on the heart.
- Physical inactivity: Lack of physical activity can lead to arterial rigidity. Damage and blockage in heart arteries can result in cardiac tissue death.
- Diet: Diets high in trans and saturated fats contribute to cholesterol buildup in arteries, impeding blood flow to the heart.
- Stress: Extreme stress elevates heart rate and constricts blood vessels already narrowed by arterial plaques.
- Alcohol use: Heavy alcohol consumption negatively impacts lipids, platelets, and heart function, increasing heart damage and sudden cardiac death risk.
- Lack of sleep: Insufficient sleep can result in prolonged elevated blood pressure.
4. Medication Review. Assess the patient’s medication history, noting drugs with potential cardiovascular side effects. Some medications can constrict heart blood vessels, increasing cardiac workload, such as:
- Anthracyclines
- Antipsychotic drugs
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Type 2 diabetes medications (thiazolidinediones and rosiglitazone)
- Recreational and illicit drugs:
- Amphetamines and amphetamine-like substances
- Anabolic steroids
- Cocaine and crack
- Nicotine
5. Assess Emotional Factors. Anginophobia, the fear of chest pain or discomfort, can trigger panic attacks mimicking MI symptoms, including tachycardia, tachypnea, hypertension, and diaphoresis. Underlying anxiety disorders may contribute to this condition, necessitating mental health support.
Physical Assessment
1. Prioritize ABCs (Airway, Breathing, Circulation). In suspected MI cases, immediate action involves calling for emergency medical services. Prioritize stabilizing airway, breathing, and circulation. Initiate CPR if the patient is pulseless.
2. Systemic Assessment:
- Neck: Assess for jugular vein distention.
- CNS: Evaluate for anxiety, sense of impending doom, syncope, dizziness, lightheadedness, and altered mental status.
- Cardiovascular: Assess for chest pain, murmurs upon apical heart sound auscultation, carotid artery bruits, arrhythmias, and blood pressure abnormalities.
- Circulatory: Note palpitations and thready pulse.
- Respiratory: Observe for dyspnea at rest or during exertion.
- Gastrointestinal: Check for nausea and vomiting.
- Musculoskeletal: Assess for neck, arm, back, jaw, and upper extremity pain, and fatigue.
- Integumentary: Observe for cyanosis, pallor, and diaphoresis.
3. Calculate ASCVD Risk. Determine the patient’s atherosclerotic cardiovascular disease (ASCVD) risk score. A low score is desirable (score < 7.5%). Risk factors considered in ASCVD risk calculation include:
- Age
- Gender
- Race
- Blood pressure
- Cholesterol levels
- Medication history
- Diabetes status
- Smoking history
Diagnostic Procedures
1. ECG Interpretation. Obtain an ECG within 10 minutes of emergency room arrival. MI may manifest on ECG as:
- Pathological Q waves: Q waves exceeding 25% of the QRS complex height, indicating myocardial infarction.
- NSTEMI: Typically does not present with ST-segment elevation. ST segment depression may be observed.
- STEMI: Characterized by ST-segment elevation.
- Troponin elevation: Both STEMI and NSTEMI involve elevated troponin levels due to cardiac muscle damage.
2. Troponin Level Monitoring. Cardiac troponins are the primary blood markers for suspected acute MI. Cardiac troponin I or T are highly sensitive and specific for myocardial ischemia. Troponin levels elevate 4-9 hours post-myocardial damage, peak at 12-24 hours, and can remain elevated for 1-2 weeks.
3. Echocardiogram. Echocardiography is crucial in diagnosing acute MI. An echocardiogram is recommended within 24-48 hours of MI onset. A follow-up echocardiogram within three months establishes a post-infarction baseline assessment.
4. Further Investigations.
- Cardiac CT scan: Accurately identifies coronary artery disease contributing to MI.
- CT coronary angiogram: Utilizes IV contrast dye for detailed cardiac imaging.
Nursing Interventions
Nursing interventions and care are vital for patient recovery following myocardial infarction. The following sections detail key nursing interventions for MI patients.
Restore Blood Perfusion
1. Facilitate Reperfusion Therapy. Primary percutaneous coronary intervention (PCI) and fibrinolytic therapy are reperfusion strategies aimed at rapidly restoring blood flow to the ischemic myocardium and minimizing infarct size.
2. Address Arterial Blockage.
- Coronary angioplasty and stent placement: This procedure involves using a balloon catheter to widen the narrowed artery and placing a stent to maintain artery patency and prevent re-narrowing.
- Coronary artery bypass graft (CABG) surgery: CABG creates a new blood vessel pathway to bypass the blocked artery, restoring blood flow to the heart.
3. Reduce Ischemia. Dual antiplatelet therapy (DAPT) is recommended for patients undergoing PCI. Common anticoagulants used include bivalirudin, enoxaparin, and unfractionated heparin.
4. Administer Blood Thinners with Caution. Blood thinners, including anticoagulants and antiplatelets, reduce MI risk by preventing blood clot formation and artery/vein blockages.
- Anticoagulants: Extend blood clot formation time by influencing chemical processes in the body.
- Antiplatelets: Prevent platelet aggregation and clot formation. Aspirin is a commonly used antiplatelet.
5. Thrombolytic Administration. Thrombolytics or fibrinolytics are “clot-busting” medications that dissolve blood clots obstructing heart blood flow. Early thrombolytic administration in MI minimizes cardiac damage and improves survival chances.
Relieve Pain
1. Pain Management. Intravenous opioids, such as morphine, are frequently used analgesics for MI pain relief. Morphine reduces blood pressure, heart rate, and venous return, potentially activating histamine-mediated mechanisms, thus decreasing myocardial oxygen demand.
2. Supplemental Oxygen Administration. Oxygen supplementation enhances cardiac tissue oxygenation and reduces ischemic pain, potentially minimizing infarct size and improving cardiac function.
3. Promote Vasodilation. Nitroglycerin remains a first-line treatment for acute MI. It generates nitric oxide, inducing vasodilation and improving myocardial blood flow, primarily used for chest pain relief.
Manage Symptoms
1. Blood Pressure Goals. Antihypertensive therapy aims to achieve specific blood pressure goals to prevent severe MI complications, as determined by the healthcare provider.
2. Maintain Blood Pressure within Acceptable Limits. Medications to manage hypertension in MI patients include:
- Beta-blockers: Reduce myocardial oxygen consumption by lowering heart rate, blood pressure, and contractility. They counteract circulating catecholamines and block beta-receptors, but should be avoided in suspected coronary vasospasm.
- ACE inhibitors: Indicated for patients with systolic left ventricular dysfunction, heart failure, hypertension, or diabetes.
- Intravenous nitrates: Effective for symptom relief and ST-segment depression regression in NSTEMI. IV nitrates are preferred over sublingual forms, with dosage adjusted until symptom resolution, blood pressure stabilization, or adverse effects (headache, hypotension) occur.
3. Lipid Management. Statin medications to lower LDL cholesterol are recommended to stabilize atherosclerotic plaques, preventing plaque rupture and vessel blockage.
4. Blood Glucose Stabilization. Acute MI-related stress disrupts normal blood glucose control, often causing hyperglycemia. Glucose-lowering treatments are beneficial to normalize blood sugar levels, regardless of pre-existing diabetic status.
Cardiac Rehabilitation
1. Adherence to Rehabilitation Plan. Cardiac rehabilitation is crucial, especially post-MI and surgical interventions. It reduces mortality risk after MI or CABG.
2. Prevent Complications and Readmissions. Cardiac rehabilitation facilitates recovery, reducing complication risk and hospital readmissions.
3. Continued Rehabilitation Post-Discharge. Cardiac rehabilitation continues after hospital discharge, typically for about three months, depending on the program and patient condition.
4. Education on Benefits. Cardiac rehabilitation improves exercise capacity, BMI, lipid profiles, psychological well-being, and quality of life in MI recovery.
Prevent MI Complications
1. Regular Exercise. Gradual exercise progression, starting with 15-20 minutes around weeks 4-6 post-MI, as tolerated and advised by healthcare providers.
2. Healthy Weight Maintenance. Maintaining a healthy weight reduces cardiac workload and MI risk associated with obesity and hypertension.
3. Teach-back Method for MI Treatments. Patient education ensures medication and treatment adherence, promoting patient-centered and continuous care. Utilize teach-back methods to verify understanding of medication regimens, follow-up appointments, and necessary tests.
4. Stress Management. Stress reduction techniques like yoga, relaxation, guided imagery, breathing exercises, and meditation are essential to mitigate stress-induced inflammatory responses, high blood pressure, and increased heart rate.
5. Underlying Condition Management. Control underlying conditions like diabetes, hyperlipidemia, and hypertension to prevent complications and recurrent MI.
6. Lifestyle Modifications. Encourage lifestyle changes to manage modifiable risk factors:
- Regular exercise and physical activity
- Heart-healthy diet
- Smoking cessation
- Stress and anxiety management
- Limited alcohol consumption
7. Regular Follow-up Visits. Recommend follow-up appointments at 3-6 weeks post-discharge for STEMI patients and outpatient follow-up for low-risk NSTEMI and revascularized patients.
8. CPR Training Encouragement. Advise caregivers and family members to undergo CPR training for emergency preparedness.
9. Action Plan During Attack. Educate patients with cardiac history on when to seek immediate medical attention, emphasizing nitroglycerin or aspirin use upon symptom onset.
10. Information on Sex After MI. Reassure patients that sexual activity is rarely an MI trigger and can resume when they feel capable of physical exertion.
11. Medical Alert Identification. Recommend medical alert bracelets or IDs to inform emergency responders about heart attack risk.
Nursing Care Plans
Nursing care plans guide assessment prioritization and interventions for short- and long-term care goals after establishing nursing diagnoses for myocardial infarction. Examples of nursing care plans for MI are provided below.
Acute Pain
Acute pain related to myocardial infarction stems from chest pain/discomfort due to inadequate cardiac blood flow.
Nursing Diagnosis: Acute Pain
Related to:
- Coronary artery blockage
- Reduced oxygenated blood flow to the heart
As evidenced by:
- Verbal reports of chest pain, pressure, or tightness
- Chest clutching
- Restlessness
- Labored breathing and dyspnea
- Diaphoresis
- Vital sign changes
Expected outcomes:
- Patient will express pain relief or control.
- Patient will report pain scores below baseline.
- Patient will appear relaxed and rest adequately.
- Patient will perform daily activities without assistance.
Assessment:
1. Differentiate Angina from MI Pain. MI pain is characterized by:
- Sudden onset, often in early morning
- Crushing substernal pain
- Possible radiation to jaw, back, and left arm
- Duration of 30 minutes or longer
- Unrelieved by rest or nitroglycerin
2. Pain Characteristics Assessment. Inquire about symptom onset, precipitating factors (activity, emotion), and pain relief measures taken.
3. ECG During Chest Pain. Obtain an ECG promptly during chest pain episodes for rapid evaluation.
Interventions:
1. Nitroglycerin Administration. For new-onset chest pain, administer nitroglycerin sublingually or buccally to dilate blood vessels.
2. Oxygen Administration as Ordered. Provide supplemental oxygen to improve cardiac oxygenation when demand exceeds supply.
3. Morphine Administration as Ordered. Morphine reduces cardiac oxygen demand, blood pressure, and heart rate, promoting relaxation and anxiety relief.
4. Evaluate Pain Control Effectiveness. Regularly assess the effectiveness of pain management interventions.
Anxiety
Anxiety associated with myocardial infarction can arise from sympathetic nervous system activation (fight-or-flight response) or pre-existing anxiety. Anxiety can also be a contributing factor to MI.
Nursing Diagnosis: Anxiety
Related to:
- Perceived threat of death
- Threat to health status
- Altered role function
- Lifestyle modifications
As evidenced by:
- Increased tension
- Fearful demeanor
- Apprehension
- Expressed concerns or uncertainty
- Restlessness
- Dyspnea
Expected outcomes:
- Patient will articulate anxiety causes.
- Patient will demonstrate understanding of post-MI lifestyle changes.
- Patient will employ effective coping mechanisms.
- Patient will exhibit reduced anxiety signs (stable vital signs, calm demeanor).
Assessment:
1. Observe Anxiety During MI. Anxiety is a prevalent psychological symptom with negative prognostic implications post-MI.
2. Identify Anxiety Cues. Recognize both subjective and objective anxiety cues in MI patients, even in the absence of chest pain complaints.
3. Assess Coping Mechanisms. Evaluate patient’s coping strategies for adapting to long-term lifestyle changes post-MI.
Interventions:
1. Validate Patient Anxiety. Acknowledge and validate patient anxieties, encouraging verbalization of feelings in a non-judgmental environment.
2. Provide Information and Answer Questions. Offer clear explanations of tests, procedures, and interventions to alleviate anxiety. Allow time for questions and provide honest answers.
3. Involve Patient in Care Planning. Include the patient in care planning to enhance autonomy and promote coping during MI treatment and recovery.
4. Stress Management. Implement stress management strategies to reduce post-traumatic stress disorder (PTSD) risk, which can negatively impact quality of life and increase recurrent MI risk.
5. Teach Anxiety Reduction Techniques. Collaborate with the patient to identify and teach anxiety reduction techniques like exercise, journaling, breathing exercises, music therapy, and medications.
Decreased Cardiac Output
Decreased cardiac output in myocardial infarction results from loss of viable heart muscle, potentially leading to cardiogenic shock and death.
Nursing Diagnosis: Decreased Cardiac Output
Related to:
- Heart rate and electrical conduction changes
- Reduced preload
- Reduced cardiovascular blood flow
- Atherosclerotic plaque rupture
- Arterial occlusion
- Altered myocardial contractility
As evidenced by:
- Persistent chest pain unrelieved by rest and medication
- Shortness of breath
- Nausea and vomiting
- Anxiety
- Cool, pale, moist skin
- Tachycardia
- Tachypnea
- Fatigue
- Dizziness
- Confusion
- Dysrhythmias
Expected outcomes:
- Patient will maintain blood pressure within provider-defined acceptable limits.
- Patient will demonstrate reduced or absent dyspnea, angina, and dysrhythmias.
- Patient will verbalize understanding of MI and its management.
- Patient will engage in activities minimizing cardiac workload.
Assessment:
1. Identify Risk and Causative Factors. Assess medical history for atherosclerosis, blood clots, heart failure, and other conditions predisposing to decreased cardiac output and MI.
2. Differentiate Angina from MI. Distinguish stable angina (activity/stress-related, relieved by rest/medication) from MI (unrelated to activity, prolonged, unrelieved by rest/medication).
3. Monitor Blood Pressure Closely. Promptly report systolic blood pressure below 100 mmHg or a 25 mmHg decrease from baseline, indicating potential cardiogenic shock.
4. Obtain ECG. ECG is crucial for early MI diagnosis, detecting STEMI, NSTEMI, and dysrhythmias.
5. Assess for Poor Cardiac Output Signs. Evaluate for cool, diaphoretic skin, weak pulses, decreased urine output, altered mental status, and peripheral vasoconstriction.
6. Assess Cardiac Enzymes. Monitor cardiac biomarkers (myoglobin, troponin, creatine kinase), particularly troponin I or T for MI confirmation.
Interventions:
1. Oxygen Administration as Ordered. Administer oxygen to enhance perfusion to the heart and other tissues.
2. Thrombolytic Therapy as Ordered. If immediate cardiac catheterization is not indicated, administer thrombolytics within 6 hours of symptom onset, monitoring for bleeding.
3. Beta-blocker Administration as Ordered. Beta-blockers reduce myocardial contractility, promote perfusion, and slow heart rate.
4. Establish IV Access. Secure IV access for immediate medication, fluid, and blood product administration.
5. Prepare for Cardiac Catheterization. Prepare for urgent cardiac catheterization to assess coronary artery blockages and potential stent placement.
6. Bed Rest and Activity Restrictions. Encourage bed rest to reduce cardiac workload and activity restrictions post-catheterization to prevent complications.
7. Cardiac Rehabilitation Encouragement. Recommend cardiac rehabilitation for patient education on diet, exercise, and recovery to improve outcomes and prevent complications.
Ineffective Tissue Perfusion
Ineffective tissue perfusion in myocardial infarction results from inadequate or blocked oxygenated blood flow to tissues and organs.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Plaque formation
- Arterial narrowing and obstruction
- Unstable plaque rupture
- Coronary artery vasospasm
- Ineffective cardiac muscle contraction
- Compromised blood supply
- Increased cardiac workload
As evidenced by:
- Diminished peripheral pulses
- Increased central venous pressure (CVP)
- Tachycardia
- Dysrhythmias
- Decreased oxygen saturation
- Angina
- Dyspnea
- Altered level of consciousness
- Restlessness
- Fatigue
- Exertional dyspnea or chest pain
- Cold, clammy skin
- Prolonged capillary refill
- Pallor
- Edema
- Claudication reports
- Numbness
- Sensation changes
- Lower extremity pain
- Poor wound healing
Expected outcomes:
- Patient will achieve normal pulses and capillary refill time.
- Patient will exhibit warm skin without pallor or cyanosis.
- Patient will maintain alert and coherent consciousness.
Assessment:
1. ECG Acquisition. Obtain an ECG within 10 minutes of hospital arrival for suspected heart attack to assess cardiac electrical activity and identify MI signs and severity.
2. Cardiovascular Status Assessment. Myocardial infarction results from prolonged coronary artery blockage, often thrombotic, leading to ischemia, reduced cardiac output, and ineffective tissue perfusion.
3. Peripheral Assessment. Evaluate skin color, capillary refill, and pulses to detect signs of cardiac blockage, including numbness, altered sensation, delayed capillary refill, diminished peripheral pulses, and skin color/temperature changes.
Interventions:
1. CPR Initiation. In suspected MI cases, initiate CPR if no pulse is detected while calling for emergency assistance.
2. Reperfusion Treatment Initiation. Implement reperfusion treatment for patients with prolonged ST-segment elevation and ischemia symptoms lasting less than 12 hours.
3. Surgical Procedure Consideration. Percutaneous coronary intervention (PCI) should be performed within 120 minutes of ECG diagnosis.
4. Fibrinolytic Administration. Administer fibrinolytics within 10 minutes of STEMI diagnosis if PCI is not promptly available (>120 minutes) to dissolve clots and restore blood flow.
5. Aspirin Administration. Administer oral aspirin immediately in suspected MI to maintain blood flow while thrombolytics dissolve clots.
6. Cardiac Rehabilitation Referral. Refer patients to cardiac rehabilitation post-discharge to improve long-term outcomes and reduce recurrent heart attack risk.
Risk for Unstable Blood Pressure
Risk for unstable blood pressure in myocardial infarction arises from blood pressure fluctuations due to compromised cardiac function, potentially leading to insufficient oxygenated blood flow.
Nursing Diagnosis: Risk for Unstable Blood Pressure
Related to:
- Ineffective heart muscle contraction
- Ischemia
- Arterial constriction and obstruction
- Unstable plaque rupture
- Coronary artery spasm
- Underlying cardiac conditions
- Increased cardiac workload
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms; interventions focus on prevention.
Expected outcomes:
- Patient will maintain blood pressure within normal limits.
- Patient will perform activities without blood pressure fluctuations.
- Patient will adhere to medication regimen for blood pressure control.
Assessment:
1. Blood Pressure Monitoring. Continuously monitor blood pressure as it may become unstable (increased or decreased) during MI due to compensatory mechanisms.
2. Cardiovascular Status Assessment. Assess cardiovascular status for potential MI complications like arrhythmias, cardiogenic shock, heart failure, pericarditis, and cardiac arrest.
3. Symptom Assessment. Monitor for symptoms associated with blood pressure changes in MI, such as headaches, chest pain, altered mental status, diaphoresis, and dizziness.
4. Risk Factor Identification. Evaluate for combined risk factors (uncontrolled hypertension, vasoconstriction-inducing conditions) increasing MI likelihood.
5. Chest Pain Assessment. Assess chest pain characteristics, noting sympathetic stimulation-induced vasoconstriction and increased cardiac workload, contributing to blood pressure instability.
Interventions:
1. Blood Pressure Stabilization in MI. Administer beta-blockers to reduce myocardial oxygen demand by lowering heart rate, blood pressure, and contractility. ACE inhibitors and calcium channel blockers relax blood vessels to lower blood pressure.
2. Vasodilator Administration as Prescribed. Administer antihypertensive medications to achieve blood pressure goals below 140/90 mmHg. ACE inhibitors and beta-blockers are indicated for patients with systolic left ventricular dysfunction, heart failure, hypertension, or diabetes. Beta-blockers are recommended for patients with LVEF <40% without contraindications.
3. Fluid Overload Management. Administer diuretics if heart failure or fluid overload contributes to hypertension.
4. Patient Education. Educate patients about the asymptomatic nature of hypertension and the importance of regular blood pressure monitoring.
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