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To purchase reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints@aacn.org. MYOCARDIAL INFARCTION H.N., a 57-year-old man, arrived in the emergency department with “excruciating” chest pain that he rated as 8 on a scale of 0 to 10 in which 0 equals no pain. Triage decisions were based on the patient’s history (pain, trigger events, and risk factors), results of initial diagnostic tests (expandedlead electrocardiography [ECG] and measurement of creatine kinase–MB [CK-MB] level), and findings on physical assessment. We selected H.N.’s case to contrast the differences in pathophysiology between inferior AMI and myocardial contusion and the differences between the two in interventions for changes in hemodynamic status and heart rhythms.

Initially used primarily as an antihypertensive, the beta-blocker carvedilol is now being used to alleviate heart failure, significantly reducing hospitalizations and mortality. In this article, we discuss the pathophysiology of heart failure; carvedilol's action, long-term benefits, and administration; and potential short-term adverse effects.

To examine the effects that a modified positioning and mobilization routine had no back pain and delayed bleeding in patients who had received heparin and undergone cardiac angiography.An experimental research design was used. Each patient was assigned randomly to either the control group, which required 6 hours of bed rest after cardiac angiography, or the experimental group. The experimental group had modified positioning, in which the head of the bed was elevated to a maximum of 45 degrees, and modified mobilization, in which they were ambulated briefly at the bedside 4 hours after angiography.Two cardiology units of a 700-bed urban teaching hospital in western Canada.All patients admitted for nonemergent cardiac angiography were approached for consent, to attain a sample of 29 patients, and were randomly assigned to the experimental or the control group.Each patient was randomly assigned before cardiac angiography. The assignment was confidential until the patient was admitted to the cardiac unit after angiography. A demographic tool and the McGill Present Pain Intensity Scale were used to collect data. Perception of pain was evaluated over four observation periods. A research assistant monitored sanguineous drainage on the dressing and hematoma to evaluate the presence of delayed bleeding.Demographic information was analyzed primarily through descriptive statistics. Results were analyzed to compare back pain and delayed bleeding between the two groups. Wilcoxon scores and t tests both were used for analysis and correlated well with each other.The group with the modified positioning and mobilization routine experienced significantly less pain overall (p = 0.02), less pain at each interval, and significantly less pain intensity (p0.05). There was no difference in bleeding. One person in each group had an estimated blood loss of more than 100 ml through the pressure dressing.This pilot study supports our hypothesis that modifying the immobilization of patients after cardiac angiography is associated with a reduction in back pain and with no increase of delayed bleeding at the femoral access site. The results support the need for further investigation of ambulation interventions after cardiac angiography.