Yes David,
I'm still lurking, just tardy in getting to the gpcg messages,
Non STEMI is a non ST elevation myocardial infarction. This includes
the spectrum from chest pain with a troponin rise and normal ecg through
to ecg changes other than ST elevation (with chest pain and troponin
ris). Hence it replaces the old term subendocardial MI.
There is technically infarction or death of some myocardium with this
process. If there is no troponin rise but chest pain with ST changes
then it is unstable angina.
On the issue of Q waves - with rapid thrombolysis and primary
angioplasty within a short time from pain onset many (if not most)
infarcts are not being allowed to fully kill myocardium in the arterial
territory. Hence ST elevation infarcts (the real deal) are now often
resolved promptly with minor damage only and no Q waves.
Final confusion - beware cases of "Tropinitis" This is a non official
term for people who come to the doctor or A/E with totally non cardiac
symptoms and the word troponin is added to their biochem. Elevation of
troponin can occur with no cardiac cause - especially seen in people
with renal impairment and sepsis. However - tropinitis is a diagnosis
made with the retrospectoscope after cardiac disease is excluded.
Duncan Guy
Cardiologist
David Guest wrote:
Ian Haywood wrote:
No, subendocardial means you don't get Q-waves, a distinction which
doesn't seem to mean much anymore. non-STEMI in practice is a "biochemical
infarct",
pathologically the area of infarction is too small to detectably alter the ECG,
however they can still cause fatal arrhythmias.
Medicine is a messy discipline. It keeps changing its axioms.
I believe non-STEMI is a new diagnostic classification that does not
necessarily "map into" myocardial infarction. Ian calls it a
"biochemical infarct", although the infarction part is not a given. I
prefer the definition of "chest symptom thing with raised troponin". Its
pathogenesis, treatment and prognosis are being elucidated and mapping
may turn out never to be appropriate.
David
P.S. Is Duncan still around?
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