How long before a cardiac cath?

[Stcroix, ASN, PhD, RN]

I am new to a cadiac tele floor. I had the lab call me for a critical trop of 11 on an new non symptomatic admit. I called the doc, they did a stat EKG, STEMI all the way. New orders came, and an order to schedule for a catheterization. There were no beds available on the cath floor, so we were told he would get the next bed. 20 hours later, still no bed. I informed the doc, and he stated that if the guy was asymptomatic and vital signs were good, he wasn't concerned. I was pooping myself because I understood that as long as a blockage exists, the potential is there for continuing loss of cardiac cells. Am I wrong for being concerned, advice please? (He did get his bed shortly after my last call to the doc)

[Christy1019, ASN, RN]

Are you sure this was a STEMI and not an NSTEMI? If this was in fact a STEMI, that hospital system has no clue what they are doing. STEMI pts are PRIORITY and are supposed to be cath'ed in 60-90min depending on policy/protocol. You are exactly right that time = heart muscle, therefore the longer the myocardium goes without reperfusion, the more dead heart you end up with, and the poorer the prognosis is. Who cares if there are no beds on the Cath floor, the pt needs the Cath lab stat and can be recovered in the PACU if need be. If this hospital is unable to provide this for a pt they should transfer them to the nearest hospital with a Cath lab!

[Flyboy17]

I agree with Christie, be sure to note if the patient actually had a STEMI. A troponin of 11 is high and usually not seen in an Acute MI, because the it hasn't had time to be created yet. Those high trops are seen in those that likely had an AMI a few days ago and the patient did not come into the hosptial or it was missed in the E.D. For a patient that has an NSTEMI current ACC reccomendations is 48hours to cath. It will soon change to 24 hours and many institutions have already adopted this. Hope this helps.

[psu_213, BSN, RN]

Is this an admit from the ER? If so, was the the trop that was drawn in the ER, but not resulted until the pt reached the floor? If the ER though they should run a trop, why did they not do an EKG? If they did do an EKG, was the one on your floor significantly different from the ER EKG? (I am not questioning you judgement or criticizing you, just looking for some clarity on the situation.)

Also, was the doc familiar with the pt or was he "just" the o/c cardiologist? I definitely find it odd that the doc would "write off" the STEMI, but he may know something about the pt that you don't know yet.

[Stcroix, ASN, PhD, RN]

I appreciate the responses guys and sorry I left out some details. The patient came up to me from ER and his first trop was .44, elevated but not scary. I got the 11 after 4 hours on the floor. My call to the doc (who was familiar with the pt because he had stented him 6 months ago) sent his PA quickly to the floor. The PA told me it was a STEMI and later in the day I looked at strips and saw the elevation of the st segment by one 'box'. I am unaware of an EKG in the ER, in the rush of things (and with 4 other patients), I did not look.

Also, an echo was done on the patient while still on my floor and the tech called me to tell me the patient had "a severe event with serious wall motion abnormalities". I also passed this along to the doc immediately that first day- still no action until the following morning.

I guess I need to study up on the difference between STEMI and NSTEMI in any event. Thanks again for the comments.

[Flyboy17]

From the sounds of things, but not knowing to full story. I would say that someone dropped the ball on this one. With a + ECG, + Wall motion abnormalities and sudden increase in Trop+. I would say he should have been cathed emergently. Again this is only my opinion for the information given.

[dannibeeRN]

Sounds like he should have been cathed immediately.