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Old 04-22-2014
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Default Workup for Patient with Chest Pain/Am I right?

Can you please confirm that this a proper workup to a patient presenting to the ER with chest pain, and likely indication of Angina/Cardiac Ischemia.

First get EKG with Enzymes>
- If this is not Confirmatory: Stress EKG Exercise, if thatís Stress EKG Exercise with Echo; or with Contrast Thalium (if cant read as in LVH, LBBB, WPW ,MVP ,YOUNG LADY ,LBBB) or if cannot Exercise at all Dobutamine Stress test (Done with Ehho to see motility of Heart Areas).
- If this proves there is likely blockage use Angiography to see how serious blockage is
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Old 04-22-2014
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Originally Posted by EmergencyMed14 View Post
Can you please confirm that this a proper workup to a patient presenting to the ER with chest pain, and likely indication of Angina/Cardiac Ischemia.

First get EKG with Enzymes>
- If this is not Confirmatory: Stress EKG Exercise, if thatís Stress EKG Exercise with Echo; or with Contrast Thalium (if cant read as in LVH, LBBB, WPW ,MVP ,YOUNG LADY ,LBBB) or if cannot Exercise at all Dobutamine Stress test (Done with Ehho to see motility of Heart Areas).
- If this proves there is likely blockage use Angiography to see how serious blockage is
yep
and give aspirin before Angiography
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Old 04-22-2014
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How do you know to continue testing rather than to say the patient home? For instance, if patient presents Chest Pain: Normal EKG/Normal Enzymes, do you return him home as this is Angina or do you continue to stress EKG, or rather do you only move to stress EKG if you have normal EKG with elevated enzymes? Also for next step; Stress EKG alone or Stress EKG + Echo? Why tap on Echo?
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How do you know to continue testing rather than to say the patient home? For instance, if patient presents Chest Pain: Normal EKG/Normal Enzymes, do you return him home as this is Angina or do you continue to stress EKG, or rather do you only move to stress EKG if you have normal EKG with elevated enzymes? Also for next step; Stress EKG alone or Stress EKG + Echo? Why tap on Echo?
im not sure , if ekg and enzymes are fine u discharge the patient from er and refer to cardiologist probably for later date

if enzymes are elevated and ekg shows no change i would treat it as nonSTEMI

there should be a clear contraindication to ekg to move to stress echo
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Old 04-23-2014
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And what are those contraindications?
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