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Which cardiac marker hangs around the longest after an MI?
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Troponin, it stays elevated for up to 14 days
What is the only way to definitively diagnosis Prinzmetals angina?
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Coronary Angiography
______________is the insertion of a catheter into the coronary artery to visualize the cause of an MI. It is used for patients with a confirmed MI, it is considered the first line of treatment.
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Emergent Percutaneous Coronary Intervention (PCI)
What complication is a concern for up to 24 hours after a PCI? What is the greatest concern for 30 days after a PCI?
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Abrupt closure can occur within 24 hours, restenosis is a danger for 30 days (that is when the risk is greatest)
What is the goal of fibrinolytic therapy and who is it used for?
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The goal is to dissolve a thrombus to stop an infarction and allow for reperfusion of the myocardium. It is used for patients that have no access to a cath lab or who are too unstable to move
How quickly does fibrinolytic therapy need to be began after the onset of MI symptoms?
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Within an hour ideally, but within 6 hours at most (mortality is reduced by 25% if started within 6 hours)
What three things are done prior to the administration of fibrinolytic therapy in a patient with an MI?
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IV lines are started, blood for baseline labs are drawn and all other invasive procedures are done to reduce the possibility of bleeding
What are the 7 things that are absolute contraindications for the administration of fibrinolytic therapy for an MI?
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-Active internal bleeding or diathesis (a fancy word for bleeding tendency), -History of cerebral aneurysm or arteriovenous malformation, -intracranial neoplasm, -history of cerebral hemorrhage, -ischemic stroke in the past 3 months, -suspected aortic dissection
What is the most reliable sign that coronary reperfusion has occurred as a result of fibrinolytic therapy?
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The ST segment on an ECG returns
What is a reperfusion dysrhythmia and what is it associated with?
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It is a dysrhythmia that results after reperfusion is achieved with fibrinolytic therapy. It usually resolves on its own
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What is the major concern after fibrinolytic therapy?
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Reocclusion of the artery from a new thrombus or a spasm. Heparin is often prescribed to prevent this.
What is a rescue PCI and what is it used for?
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A rescue PCI is used in patients who have undergone fibrinolytic therapy successfully, but has developed another clot
What is the major concern DURING fibrinolytic therapy?
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Bleeding. A drop in BP, increase in HR, decreased LOC, or blood in the urine or stool require stopping the therapy and telling the doc.
There are four indications for a Coronary Artery Bypass Graft (CABG) surgery, they are:
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-medical management has failed -patient has left main artery disease OR three-vessel disease -Patient is not a candidate for PCI (long lesions or difficult access) -PCI was performed but chest pain is ongoing
Coronary Artery Bypass Graft surgery requires a ________, which is a surgical opening of the chest cavity.
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Sternotomy
Coronary Artery Bypass Graft (CABG) surgery requires the use of cardiopulmonary bypass (CPB). What is it?
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Diversion of a patient's blood from the heart to a bypass machine which oxygenates it returns it to the patient
What is the most common artery used for a Coronary Artery Bypass Graft (CABG)?
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The internal mammary artery (IMA)
Which arteries are most commonly used for a Coronary Artery Bypass Graft (CABG)? (5)
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Internal Mammary Artery, Saphenous vein (leg), radial, gastroepiploic artery, or inferior epigastric artery
What are the drawbacks to using the saphenous vein for CABG?
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They develop diffuse intimal hyperplasia, increasing the chance of stenosis, the patency rate is 66% at ten years
What are the drawbacks to using the radial artery for a CABG?
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It is prone to spasm when mechanically stimulated, patency rate is 84% at 5 years
Which patients are most likely to have a CABG using the gastroepiploic or inferior epigastric artery?
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Those that have had previous CABG surgery
  
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