Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of substernal chest pressure radiating to the left arm, occurring [Time] post-CABG. Symptoms are associated with diaphoresis, dyspnea, and nausea. No relief with sublingual nitroglycerin. History significant for coronary artery bypass grafting on [Date]. Current symptoms are consistent with myocardial ischemia in the context of prior surgical revascularization.
Clinical Examination Findings
General: Patient appears in acute distress, diaphoretic. Cardiovascular: Tachycardic/Bradycardic, S1/S2 present, no murmurs, rubs, or gallops. Surgical site: Midline sternotomy incision is well-healed without erythema, warmth, or purulent drainage. Lungs: Bilateral crackles at bases, suggesting mild pulmonary congestion. Extremities: No peripheral edema, pulses 2+ bilaterally.
Treatment Protocol
Initiate NSTEMI protocol: Dual antiplatelet therapy (DAPT) with Aspirin and P2Y12 inhibitor. Start intravenous heparin infusion per weight-based protocol. Administer high-intensity statin therapy. Optimize beta-blocker and ACE inhibitor/ARB titration. Monitor serial cardiac enzymes (Troponin I/T) and continuous ECG telemetry. Consult Cardiothoracic Surgery for evaluation of graft patency and interventional cardiology for potential coronary angiography.