The patient with unstable angina or a NSTEMI can have a delayed angiogram within 48 hours of admission. While the ECG is most important, serial cardiac markers are also important. The main cardiac enzyme involved is the CK-MB enzyme, while markers of cell contents of myocardial cells include troponin I, myoglobin, and troponin T. These are seen at different times but the troponins are far more sensitive and are seen earlier in the bloodstream compared to the cardiac enzymes. In some case, the test is too sensitive and the chance of false positivity does exist. For this reason, the results seen must be balanced with the symptoms, risk factors, and ECG findings. The coronary angiography is both diagnostic and therapeutic if combined with percutaneous coronary intervention. If done soon after an MI, it can effectively abort the process so that the amount of coronary damage will be minimized. Besides being able to resolve the ischemia, the angiography can assess the other coronary arteries as well as things like ejection fraction. Other imaging techniques, like echocardiography or radionuclide scanning, will not generally be helpful. The treatment starts in the prehospital setting with aspirin, oxygen, nitrates and possible ECG to expedite diagnosis and further management. An IV is started and continuous cardiac monitoring is accomplished. Morphine was once suggested but there are adverse outcomes associated with it. Drug therapy can involve antiplatelet drugs like aspirin or clopidogrel, anticoagulant drugs, or fibrinolytics, such as tissue plasminogen activator. Many patients will have percutaneous coronary angiography, while a few will not be candidates for this and will require a coronary artery bypass graft or CABG.
ARRHYTHMIAS Cardiac arrhythmias can happen for a variety of reasons, including ischemic heart disease, congenital diseases of the heart, electrolyte abnormalities, toxins or drugs, and hormonal imbalances, such as low thyroid conditions and hyperthyroidism. Among drugs or toxins, both caffeine and alcohol are contributors to cardiac arrhythmias. Cardiac tissues can be called fast-channel or slow-channel tissues. The fast-channel tissues are the working myocytes and the cells of the His-Purkinje system, which are 7
