Just to confuse this issue is the 'official' change in nomenclature to Acute Coronary Syndromes- which includes STEACS - ST Elevation ACS and NSTEACS - non-ST elevation ACS (Previously NSTEMI) http://www.mja.com.au/public/issues/184_08_170406/suppl_170406_fm.html -refer MJA April 2006
May 2006 Please Note new email address [EMAIL PROTECTED] Regards Les Bolitho Dr Leslie E Bolitho Consultant Physician in Internal Medicine MBBS FRACP FACRRM 6 Dixon Street, Wangaratta .Vic.3677.Australia Phone 61 3 5721 5533 ; Fax 61 3 5722 1781 Mobile 0418 574 463 ; email: [EMAIL PROTECTED] -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Duncan Guy Sent: Wednesday, 19 July 2006 7:36 AM To: General Practice Computing Group Talk Subject: Re: [GPCG_TALK] T'was brillig and the slithy toves 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 > _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
