I'm taking Dad to the clinic tomorrow. 

When I arrived at my parent's apartment Saturday morning, Mom said the aide had just brought in some Tylenol for Dad because his back was hurting. (I confirmed this with the aide) I didn’t think anything of it until he had another spasm, then I realized it was angina – the same severe cramping pain just under his shoulders. I gave him his nitro pill and within a short time he was doing much better. Mom and Dad both said this was the same as the pain he had earlier.

There was not a nurse or even an LPN on duty all weekend. I talked with the Med Techs about Dad’s angina and let them know how it shows up with Dad. They had no idea heart pain could show up that way. They do not have an RN on staff at this time.

This morning, he had more angina and I was told he had been given two pills. Mom told me Dad has these episodes of pain every morning.

My questions for the doc - and for you:

Is there something we can do with the medicines to prevent the morning angina attacks which may be coming before the more long lasting medication has taken effect?

How much nitro can he have? (I will need to tell the med tech aides. I don’t think they know.)

When he has the angina pain, when is it appropriate to seek more help, and who do I call – his PCP, cardiologist, go to emergency room – taking into consideration his DNA order?

Also, if he’s had two or three episodes of angina in a short period of time in the morning, is it still okay for him to walk down to the dining room for his breakfast? Or should he be resting?

Basically, I’m realizing that, depending on whether the facility has proper staffing, (shouldn't an assisted living facility have a nurse on staff?) it may come down to me having to decide what is going on and whether or not to take him to the hospital. I'd be grateful for any thoughts or advice, especially from those who've cared for people with heart conditions. The heart stuff is all new to me.

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Diane Glittenberg CDP,CCC,CCE

Goldie,\r\n\r\nYou certainly have allot on your plate and you have every right to feel frustration at the facility, or with the sides for not recognizing the symptoms. \r\nIn my experience with my father, the Dr. told us if he had to take 3 nitro pills he then must go to the ER. That was several years ago now, but I would check with his cardiologist to make sure. If I remember correctly we were able to get Dad's angina under control by making medication changes.\r\nWith regards to the nurse being there in an assisted living facility, I'm not sure if they have to have one there all the time or not, but I would think that there should be an on call person available. .\r\nIf​it were my father I would take him in. \r\nGood luck. I know this heart disease stuff is hard to get used to. You seem to be on top of things though. Make sure to ask all the questions you need to before the Dr. leaves the room. \r\nGood luck.\r\nDiane