Mnemonic Monday: MONA + LMNOP – What to do 1st when your patient has a “broken heart”…

By Molly Lewis

When a patient presents to you with something as life threatening as a heart attack or acute heart failure, it can be hard to think clearly. Use these mnemonics to quickly remember what to do!

MONA + LMNOP HeartFor a suspected heart attack (myocardial infarction/MI), remember MONA:

  • Morphine
  • Oxygen
  • Nitroglycerin
  • Aspirin
(This rule isn’t true for all of heart attacks. For example, in a pure right ventricular infarction, it’s best to avoid vasodilators like nitroglycerin (NG) in order to maintain venous return so the weakened right ventricle gets enough blood coming into it that at least some of it will make it out of the RV, into the LV, and out to the tissues! Also, it’s best to avoid NG in patients who are in cardiogenic shock (i.e. are hypotensive)).

In addition to MONA, there are other important urgent treatment strategies for MI’s, but….  For most heart attacks, MONA is an excellent 1st step treatment strategy.

 

For acute heart failure / a CHF exacerbation (i.e. a patient presenting with acute pulmonary edema), remember LMNOP:

  • Lasix / Loop diuretic
  • Morphine
  • Nitroglycerin
  • Oxygen
  • Position: Prop up the patient

Look how similar the 1st steps of treatment of acute heart failure are to the 1st steps in treating an MI! This treatment is just the MON of MONA plus a loop diuretic and elevating the head of the patient’s bed.

(By the way, the cause of the patient’s acute heart failure could be an MI, in which case you could use both treatment strategies!).

Now that your patient is stabilized using MONA or LMNOP, you can take a minute to catch your breath and plan the strategy for the rest of his or her treatment!

 

Bonus fact:

Why use morphine to treat a heart attack or heart failure?

It causes venodilation! This reduces preload and therefore decreases the myocardial oxygen demand. Plus, it relieves the pain and anxiety involved in an acute MI. Helping the patient relax reduces catecholamine release, which leads to a slower heart rate, further decreasing the amount of oxygen needed by the heart. So, it’s calming ability makes it especially useful in a patient who is restless and short of breath.

 

Stay tuned for my next mnemonic, which will help you remember what, other than an acute MI, could have caused your patient to go into acute heart failure!

 

Bibliography:

MONA mnemonic: http://www.fpnotebook.com/cv/cad/ActCrnrySyndrmImdtMngmnt.htm

LMNOP mnemonic: http://apotential.wordpress.com/medical-mnemonics/ Congestive heart failure acute exacerbation treatment: https://online.epocrates.com/noFrame/showPage.do?method=diseases&MonographId=62&ActiveSectionId=42

 

Discussion

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