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Old 10-20-2012
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Default patient with substernal chest pain

A 48-year-old man presents to the emergency department 1.5 hours after the onset of severe substernal chest pain radiating to his left arm. The pain is accompanied by diaphoresis and shortness of breath. His blood pressure is 165/94 mm Hg, pulse is 82/min, and respiratory rate is 18/min. Which of the following tests is the most important tool in the initial evaluation of patients in whom acute myocardial infarction (MI) is suspected?

A AST
B CK MB
C EKG
D Echocardiogram
E LDH
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Old 10-20-2012
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will go with C) EKG ---as initial evaluation is asked and ekg can be easily taken ..

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Old 10-21-2012
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C) EKG is the answer.

But hey guys, lets suppose the questions has options which have both EKG and Troponins, then what will be the answer? Will it still be EKG? Do we have any reference to back it up??
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Old 10-21-2012
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Quote:
Originally Posted by nooranimm View Post
C) EKG is the answer.

But hey guys, lets suppose the questions has options which have both EKG and Troponins, then what will be the answer? Will it still be EKG? Do we have any reference to back it up??
i think it's still an EKG for initial evaluation of any MI case...but anyhow wait for the answer too...
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Old 10-21-2012
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Quote:
Originally Posted by MedicalExaminer View Post
A 48-year-old man presents to the emergency department 1.5 hours after the onset of severe substernal chest pain radiating to his left arm. The pain is accompanied by diaphoresis and shortness of breath. His blood pressure is 165/94 mm Hg, pulse is 82/min, and respiratory rate is 18/min. Which of the following tests is the most important tool in the initial evaluation of patients in whom acute myocardial infarction (MI) is suspected?

A AST
B CK MB
C EKG
D Echocardiogram
E LDH
First few hrs ( may be 1-4 hrs) ECG
Then CK MB, AST , TROPONIN 1


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The correct answer is C. ECG is the gold standard for diagnosing MI within the first 6 hours of symptom onset. ECG changes will include ST-segment elevation (signifying transmural infarct), ST-segment depression (signifying subendocardial infarct), and Q waves (signifying transmural infarct).

Serial measurements of creatine kinase-myocardial bound (CK-MB) fraction along with troponin-I are made in every patient with suspected MI. However, since these enzymes take 46 hours to accumulate in the blood, and ECG results can be obtained faster, ECG is the initial test when triaging a patient with suspected MI. CK-MB levels peak around 24 hours and are negative at 3 days post-MI.
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