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Query about MI latent - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Hypertension and Heart Disease
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
User :   Case scenario: 55 year old man admitted to the unit with acute coronary syndrome. Tells me that he came into the hospital because of an episode of chest pain that he developed while out for a walk. He described his pain as a pressure sensation rated 7/10. Pain was retrosternal, nonradiating and subsided after talking 2 sprays of nitro. Pain was accompanied by nausea and diaphoresis. He states that he has been having recurring chest pain over the past week when walking. He is pain free at present. His breathing is unlaboured, resp are quiet, chest is clear, skin warm to touch, colour is pink, BP 142/88, Sao2 99% on 3L by nasal prong, weight 116.5kg. He is on numerous meds for high B/P, diuretics, blood thinners, he's diabetic type 2. His EKG had normal sinus rhythm....CK levels 243U/L and troponin at 0800 where
Doctor :   Hi,
Doctor :   dr xxxx here
User :   Hi there
Doctor :   Please give me a couple of minutes to read your post
User :   ok
Doctor :   Ok, the lab parameters are normal
Doctor :   may i ask some details of the pain ?
User :   sure, although this is a case scenario and I just wanted to know if I was on the right path
Doctor :   ok ,Was the pain gripping in nature ?
User :   It just states that it was a pressure sensation
User :   retrosternal nonradiating
Doctor :   ok, may i know the exact time of the day when thye pain occurs ?
Doctor :   the *
User :   before 0800 because lab results came in at that time
Doctor :   ok,
Doctor :   is the pain related to food intake if so please explain ?
User :   unsure that is not stated
Doctor :   ok, i still consider it to be a MI , but a latent one
User :   would you say this is just an angina attack
Doctor :   hence to get the diagnosis confirmed i would suggest the patient to get a Thread mill test
Doctor :   i mean Exercise stress test
Doctor :   which will precipitate ant latent coronary occlusions ( MI )
User :   are the troponin levels at 0.02 and 0.08 normal is that high because from what I have been researching it states that under 0.2 is normal
Doctor :   no, above 0.1 is abnormal
Doctor :   anything below it is normal
User :   so it being 0.02 and 0.08 that is below 0.1 correct^
Doctor :   yes,
User :   therefore with those troponin levels wouldn't state that there was no MI involved?
Doctor :   yes, but do not rule out latent MI
User :   can you explain that just a little please
Doctor :   yes,
Doctor :   latent MI ther block in the coronary arteries supplying blood to the heart wall be blocked minimal , so as they do not induce a MI attack in rest , hen the person is in stress like exercise or any work
Doctor :   the need for oxygen by the heart will be more
Doctor :   hence the blood needs to be pumped more but the block do not compromise and lead to MI
User :   and taking nytro will subside this
Doctor :   yes,
User :   ah ok
Doctor :   thats one fevouring fact towards MI ( latent)
User :   but he is at great risk of a full blown MI to come?
Doctor :   yes, for sure
Doctor :   and after thread mill test and confirmation of MI latent , he may need Angiography
User :   perfect thank you very much for time you have answered all my questions
Doctor :   thanks for consulting me , kindly provide your feedback
Doctor :   is there anything i can help you with ?
User :   no will end the chat thanks again!
Doctor :   Ok,
Doctor :   thanks for consulting me , kindly provide your feedback
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