[Tele_Nurse4u]

Hell everyone! Quick question. I work in a tele/cardiac unit and am a pretty new nurse. My patient today was admitted with chest pain, sob. Hx included IDDM, MI, many stents through the years and finally quadruple bypass 2 months ago... I realize that troponins will be elevated for a while after CABG, but HOW LONG? His troponin upon amission was 0.29 and before i left(12 hrs later) was 0.40. Still exp acive chest pain, unrelieved by nitro, pt refusing morhpine. only motrin ordered which REALLY WASNT helping. BUN and creat were 19 and 0.9. No hx of renal issues. When i talked to the cardiologist, he said 'hes okay as long as hes not having chest pain. I said "BUT HE IS!!" He replied well, "i will just see him tomorrow... HIs pain is probably from his surgery...just his chest wall.." he was in a super hurry (as usual) and hung up! nothing new right..LOL

SOOO..anyways i guess my questions are:

How long do troponins normally stay elevated after cabg??
and
Should troponins be GOING UP????? I assumed they would at least stay the same...but i dont know~!

thanks in advance guys

[Spatialized]

Troponins would not be elevated 2 months post-CABG. An increase in troponins like that wold be a bit worrisome, especially in the light of concurrent chest pain. They should not be going up - that means something is going on.
My first real nasty ICU transfer involved a guy 4 months out from CABG who clotted off all but 3 of his grafts, then clotted the 4th on my shift. Just because they got bypass doesn't mean they can't/won't reinfarct, especially if they continue previous bad habits and medication non-compliance.

Hope this helps.
Tom

[ckc6977]

I agree c the previous poster. Pts should not have + troponis s/p CABG. I've have several pts s/p CABG who have re-infarted. Was there anyone else you could have gone to for further eval of your pt?

[Dinith88]

Originally Posted by ckc6977

who have re-infarted.?

Sorry..the child in me got a laugh out of your mis-spelling.

[Haldolallergy]

Agree with all of the above....but what did the EKG look like?
My little red cardiac nurse flags are going up all over for this guy....
Is it a teaching hospital? Anyone above this cardiologist who said to wait til tomorrow? Troponins won't be elevated 2 months after CABG, especially with the normal Cr. value.

[Tele_Nurse4u]

Thanks everyone. It is not a teaching hospital. It is actually a nonprofit "we take anybody hospital.' not to say its not a good hodpital because it is i am sooo not afraid to ask questions, but docs kept telling me it was fine and other nurses i work with were kinda like me..."what??....." WE were all confused!! LOL
Anyways..I am glad I am not alone in my concerns : )I kn ow i wasnt crazy. He was normal sinus on monitor, with st depression. Nothing really.

I really think this guy infarcted. Even his admitting doc was kinda blowing it off. So here i have 2 docs (admitting and cardio) telling me hes fine. When I went back a few days later, the guy had been discharged. He didnt die that I know of
I only hope everything went well!!!

Well, thanks everyone sooo much!!!!!

-Steph-

[Tele_Nurse4u]

Originally Posted by Haldolallergy

Agree with all of the above....but what did the EKG look like?
My little red cardiac nurse flags are going up all over for this guy....
Is it a teaching hospital? Anyone above this cardiologist who said to wait til tomorrow? Troponins won't be elevated 2 months after CABG, especially with the normal Cr. value.

I agree.. And that was the first thing he asked me, and they were well WNL. Thanks for helping!!

[Haldolallergy]

sorry so late in replying! I am glad everything worked out! You did a great job and next time you'll be all ready for this situation