There are two separate ways the heart fails you, and you have to sort which one you're looking at before you touch a drug.
Acute coronary syndrome is a supply problem. A coronary artery narrows or blocks, and the muscle downstream doesn't get the blood it needs. That's ischemia, and if it goes on long enough, that muscle dies.
Heart failure is a pump problem. The ventricle can't move what it receives, so blood backs up behind it. Fluid ends up in the lungs, or in the body, depending on which side is failing.
They're not unrelated. A big infarct can knock out enough muscle to cause heart failure on the spot. A heart that's already failing is more prone to ischemia, because it's working harder with less reserve. Your job on scene is to ask which problem is in front of you right now, because the treatments pull in different directions. Aspirin is for the supply problem. Sitting the patient up and CPAP are for the pump problem. Nitroglycerin, per protocol, helps both: it opens the coronary arteries and takes pressure off a backed-up pump.
Quick check
A patient's ventricle cannot move the blood it receives, and fluid is backing up into the lungs. Which treatments target this pump problem?
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