Elizabeth Dodd wrote:
On Wednesday 19 July 2006 02:26, Duncan Guy wrote:
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.
Nothing wrong with the term which describes the pathology rather than the
secondary effects on biochemistry and electrical conductivity.
The problem was that "subendocardial" infarction almost never occurred
pathologically. It usually patchy necrosis, some transmural. There is
a clear distinction in management and future risk based on ST elevation
being present, hence the term reflects the probable outcome for the
patient rather than an inaccurate pathological term.
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.
there are a number of benign causes of troponin rise eg marathon running
and the spread of another term represents again the problem with persons who
never enquire into how-and-why something happens but whinge that there is no
perfect path test for a coronary occlusion.
Tropinitis is not a real term - its just a slang term. Marathon runners
have troponin rises, probably because of coronary ischaemia secondary to
lactic acidosis and extreme metabolic demand. This is why they have
abnormal hearts. Similarly people with pulmonary embolism have troponin
rises - due to acute right heart strain and myocardial enzyme release.
There is no perfect biochem test and probably never will be. If you are
thinking of ordering a troponin on someone with chest pain they should
be treated as if they have coronary ischaemia until proven otherwise
Duncan
Liz
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