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How can Nstemi be diagnosed without having any blood work done?

DOCTOR OF THE MONTH - Jan 2017
Jan 2017
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Cardiologist
Practicing since : 2013
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How would someone know they had a NSTEMI without having any blood work done? Does it cause EKG changes later? How long do heart attack symptoms last if someone doesnt go to the hospital? Like if its a mild heart attack. Also does it matter to a cardiologist if a patient has ehlers danlos? Or is that insignificant?
Fri, 27 Apr 2018 in Hypertension and Heart Disease
 
 
Answered by Dr. Sagar Makode 25 minutes later
Brief Answer:
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Detailed Answer:
Hello,
Nstemi diagnosis needs two things, one is ecg changes and other is troponin test positive. If there are no ecg changes then we get serial ecg at one hour interval and see for changes. If there are no changes then its less likely to be nstemi. Secondly, troponin test should be positive, and if it's negative but ecg changes are present then it is called as unstable angina, a very mild form heart attack. If ecg and troponin, both are normal and symptoms are very typical of heart attack then we go for treadmill test or stress thallium test to confirm the heart as a cause of pain.
Pain of nstemi may last from 12-24 hours without treatment, while that of unstable angina from 10-30 min.
Its matter if someone has ehler Danlos syndrome as it can affect coronary arteries, and such patients will need angiography if heart attack is suspected.
Hope this helps you and get back if you have any doubts.
Above answer was peer-reviewed by
 
Follow-up: How can Nstemi be diagnosed without having any blood work done? 27 minutes later
Why would they need angiography? Wouldn't it show on the EKG ? I had an episode about two weeks ago that lasted around 4-5 hours. The symptoms waxed and waned in intensity. The strongest feeling was a burning/aching/heaviness in the inside of my upper left arm. Sometimes I would get an aching in my right armpit. I would get this burning/tightness or pressure in my chest, sometimes it felt like it was going to my back. I felt super tired and overall very uneasy. People were asking me if I was ok because I was at work and trying to stay busy but I looked ill. I had called my cardiologist that I had seen before because of POTS and clearance for surgery because I had slight EKG changes after I had a similar episode before and was told I had vasospasms. But that episode was in my right arm and rarely in my left arm and slight uneasiness in my chest but not all the other stuff. My cardiologist said he didn't think it was cardiac pain so I never sought treatment. Now I am going to see a rheumatologist because multiple doctors said I meet criteria for Ehlers. I dont know what to do, because this really feels like my heart but my cardiologist dismissed it. I didn't know if he would think differently if I mentioned Ehlers or not.
 
 
Answered by Dr. Sagar Makode 30 minutes later
Brief Answer:
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Detailed Answer:
I meant angiography if suspected on noninvasive investigations like ekg or stress testing, echo.
Your symptoms are atypical and not very compatible with nstemi or unstable angina. So probability of any cardiac issues is less. Your ecg is not available but from your opinion, the changes must not be significant to go for further investigations.
But I would consider treadmill test or echo cardiography in order to rule out the disease since it may not be possible to rule out disease on the basis of symptoms only, but yes likelihood is less. All the best.
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