Q:

Following successful thrombolytic treatment of the patient in the previous question, he develops recurrent chest pain in 24 hours. The following is/are true:

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Following successful thrombolytic treatment of the patient in the previous question, he develops recurrent chest pain in 24 hours. The following is/are true: 


  1. Rethrombosis is most likely and thrombolytic therapy alone should be repeated
  2. The problem could have been prevented by early elective catheterization and PTCA
  3. Patient has an indication for catheterization and PTCA if single vessel disease is found
  4. Findings of multivessel disease at catheterization would indicate need for operative bypasses
  5. If operative bypass is deemed necessary, there should be a 30-day delay to allow myocardial healing

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c. Patient has an indication for catheterization and PTCA if single vessel disease is found

d. Findings of multivessel disease at catheterization would indicate need for operative bypasses

After thrombolytic therapy for acute MI, angina recurs in 30%–35% and is an indication for cardiac catheterization and mechanical intervention to prevent infarct extension. Prophylactic catheterization, however, has not been found to provide benefit. If the findings at catheterization show limited disease treatable by PTCA, then it should be performed. But if multivessel disease or unfavorable anatomy is found, operative bypass should be carried out early since results are best within 30 days of the MI.

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