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Old 03-02-2014
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Default Diagnosing MI in a patient with prior MI/pacemaker/old LBBB

Kaplan qbank says in these 3 conditions (and if patient is on digoxin), if a patient presents with suspected MI; the "next best step in management" would be a "bedside ECHO" and NOT an EKG.

This sounds weird. I did some research and I could not find a reference suggesting this.

Do any of you guys have an idea on this? Does Uworld discuss this issue?
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Old 03-05-2014
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Quote:
Originally Posted by DNA 105 View Post
Kaplan qbank says in these 3 conditions (and if patient is on digoxin), if a patient presents with suspected MI; the "next best step in management" would be a "bedside ECHO" and NOT an EKG.

This sounds weird. I did some research and I could not find a reference suggesting this.

Do any of you guys have an idea on this? Does Uworld discuss this issue?
yeah, i think its because in the conditions above the baseline ECG is already abnormal, hence you would not know what to make of the ECG you see. hence the ECHO
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Old 03-05-2014
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I noticed this question as well. Its just yet another example of where kaplans world can be vastly different to clinical practice. In ANY patient with ANY cardiac history with chest pain, regardless of old EKGs, the FIRST investigation is always always going to be an EKG. Yeah you might just see LBBB, but there are sometimes ischemic changes seen superimposed, especially if an old EKG is available for comparison. Also, not doing an EKG would mean you'll miss any arrhythmia.

In real life no one in their right mind is gonna wait around to get a cardiologist down to the ER to do an echo while your patient is sitting with chest pain without looking at an EKG.

I honestly dont know how id answer this if it came up on the real exam, if it asked for the NEXT step, id still answer EKG. i just hope it doesnt.
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Old 03-05-2014
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Kaplans internal med is full of sh*t honestly. Ive just read an explanation on endocarditits in a patient with a "harsh murmur", which says that "echocardiography is done if blood cultures are positive". Really kaplan?
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Old 03-05-2014
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i agree because after MI ECG will still abnormal for whole life..so only Echo is accurate ... watch kaplan video for cardio,,,itd Fishers lecture aand he gave good explanation for MI
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yeah echo will be more accurate than ecg in identifying ischemia, but the question asked what the next best step is. EKG takes seconds and not doing it means you would potentially miss any arrhythmia associated with the ischemia.

Are ER physicians in the states really routinely trained that well with bedside cardiac echo?!
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Old 03-05-2014
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Quote:
Originally Posted by Rochelle View Post
yeah, i think its because in the conditions above the baseline ECG is already abnormal, hence you would not know what to make of the ECG you see. hence the ECHO
OK! I eat my words, you were right guys, check this out
http://en.wikipedia.org/wiki/Sgarbossa's_criteria
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Quote:
Originally Posted by Rochelle View Post
OK! I eat my words, you were right guys, check this out
http://en.wikipedia.org/wiki/Sgarbossa's_criteria
This is exactly what I led myself to while researching for it. That's CK for you. Step 1 was so much more objective grrr.
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