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Old 01-28-2013
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Arrow Billy Step1 Questions # 106

Myocardial Infarction Evaluation:

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) Aspartate aminotransferase
(B) Creatine kinase-myocardial bound
(C) ECG
(D) Echocardiogram
(E) Lactate dehydrogenase
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B creatine kinase MB
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ecg


ecgecgecg
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Quote:
Originally Posted by billy View Post
Myocardial Infarction Evaluation:

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) Aspartate aminotransferase
(B) Creatine kinase-myocardial bound
(C) ECG
(D) Echocardiogram
(E) Lactate dehydrogenase
aminotransferases non specific,
ck-mb rises 4-6 hours after MI
Lactate dehydrogenase: 2-7 days
troponin I & T: rise within 2-4 hrs(not in option)
ECHO mostly done for valvular heart diseases
ECG:Answer of this question
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ECG ryt. ??


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initial evaluation of patients - ECG n later i guess CK-MB
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CK-MB- appears within 4to8 hours,peaks at 24 h disappears within 1.5-3 days.reappearance after 3 days-reinfarction
TROPONINS I AND T-appear within 3to12 h ,peaks at 24h,disappears within 7 to 10 days
LDH1-2 -normally LDH2 is higher than LDH1 in AMI, LDH1 in cardiac muscle is released ,causing the ,,flip'' .LDH1-2 appears within 10 h, peaks at 2to3 days,disappears within 7 days
in the first 6 h ECG is the gold standard
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ecg! and after that preferably troponin, ck-mb
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Quote:
Originally Posted by billy View Post
Myocardial Infarction Evaluation:

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) Aspartate aminotransferase
(B) Creatine kinase-myocardial bound
(C) ECG
(D) Echocardiogram
(E) Lactate dehydrogenase


Its ECG. In first 6 hours of diagnosing MI, ECG is the gold standard. From ECG, you will see whether there's ST elevation or not.

If there's ST elevation based on ECG, then you wait atleast 4 hours of onset of MI (in this case 2.5 hours) and check for Troponin - which is specific protein marker of MI.

Troponin arises after 4 hours and is elevated for 7 - 10 days.

So, bottom of line - ECG is gold standard in first 6 hours of MI.
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ECG is d ans
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Old 01-29-2013
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Correct Answer C is correct

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).
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The above post was thanked by:
mayankkaushal (02-12-2013), nandish_m (01-29-2013), zeal7 (01-29-2013)



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