I’ve always remembered the treatments for Heart Attack as the mnemonic MONA. But I heard that the American Heart Association (AHA) has changed their recommendation and now are recommending Aspirin as the first treatment to give for Heart Attack. How does that affect MONA?
~ Submitted by Paul
First, for those who don’t already know, MONA is a mnemonic that stands for: Morphine, Oxygen, Nitrates, and Aspirin. These are the 4 primary interventions that are performed when treating a patient with Heart Attack/Myocardial Infarction (MI). However, what many students don’t realize is that MONA does not represent the order in which you should administer these treatments as a nurse. It is a mnemonic intended to help you remember the components of MI treatment, not the prioritization of them.
In a medical setting, when you are treating a patient with MI, you give Oxygen first, then nitrates, then aspirin, then morphine. The rationale is that we have two therapeutic goals: 1) decrease cardiac oxygen demand (usually by slowing the heart rate), and 2) increasing available oxygen.
So the Oxygen is always given first to start increasing the amount of available oxygen in the blood. Then nitrates are given to vasodilate blood vessels, which allows more room for blood to pass through. Then the aspirin is given to help “thin” the blood by breaking down platelet to get rid of any clots in the coronary arteries that might be contributing to the MI. Finally, morphine can be given to reduce pain and anxiety, which in turn helps decrease oxygen demand. Morphine also slows the heart rate and has a vasodilating effect, but it’s usually only given if the nitrates did not relieve the chest pain or if the patient is having anxiety.
You probably heard the “aspirin comes first” recommendation because if a patient calls 911 for chest pain, they will be instructed to take an aspirin while waiting for the ambulance. But as soon as the EMTs arrive, I guarantee that they will slap on that Oxygen mask! So always look at the context of the question if you see something like this on an exam. If the patient is in a medical setting, you will probably be doing Oxygen first. If they are in a non-medical setting, then it might be nitrates first (if the patient has them available for angina episodes), or aspirin first if nitrates are not available.