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How is Acute Coronary Syndrome detected ?

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Internal Medicine Specialist
Practicing since : 2007
Answered : 362 Questions
55 year old female. hypertension,tingling left arm and shoulder,mild toothache,cold sweat and extreme fatigue?
1)What is your overall medical impression?
2)For patient medical history, including family history, what questions would you ask to make your diagnosis (diagnoses) for Susan? Why?
3)What physical examination would you do to help you make a diagnosis?
4)What laboratory tests would you order to rule in or out the possibilities? Why?
Second Question:
2 XXXXXXX is 70 year old nurse. She wakes up to find her skin more yellow than usual. She comes to your office. 1)What lab test could you order to confirm that she has jaundice?
1)How would you construct your list of questions to XXXXXXX in order to find the causes of her jaundice? You may list your questions as the following:
a.Family history
b.Medical history
2)What physical examination would you do to help you think? Why?
3)What laboratory test(s), including imaging tests would you order? Why?
Posted Thu, 26 Apr 2012 in Valvular Heart Disease
Answered by Dr. Kiran Kumar 2 hours later
Hi Byogol,
Thanks for the query,

Patient 1

Answer 1. 55 year old female with hypertension, has come with tingling left arm and shoulder and mild tooth ache. There is cold sweat and extreme fatigue. It prudent that in such cases with arm discomfort and tooth ache with severe fatigue, you rule out Acute Coronary Syndrome (ACS). Although in ACS, there will e more of an arm discomfort or pain, some patient scan have tingling and numbness too. Nothing else fits in this diagnosis. So most likely diagnosis is Acute Coronary Syndrome. Since patient has severe fatigue, its advisable that we rule out associated Anemia.

Answer 2: I would like to know if she had had any symptoms suggestive of ischemic heart disease.
Any Exertional Chest/arm Discomfort or pain ?
Any Exertional Shortness
of Breath ?
Any previous known heart disease ?
Any history of Anemia ?

Answer: 3
A detailed cardiac evaluation including examination of pallor, JVP and Chest for Crepitations

Answer 4:
Cardiac Enzymes, Complete Hemogram
This will help to assess if there is any ongoing cardiac muscle injury.

Patient 2:

Answer 1. I shall order Serum Bilirubin - Direct and Indirect and Liver Enzyme Testing (SGOT/SGPT and Alkaline Phsophatase)

Answer 2:
History related to causes of Jaundice:
a. Any recent infection/diarrhoea to evaluate for any recent Viral Hepatitis
b. Any history of alcohol intake
c. History of Right upper abdominal pain/Pain abdomen
d. Any previous Blood related Disorders such as Thalessemias or any hemolytic disorders
e. An previous know liver disease
f. Any weight loss

Family History:
Any family history of Jaundice or cirrhosis - for Wilsons Disease
Any known malignancies in family: Pancreas etc

Answer 3.
Examination for Pallor, Icterus
Evaluate liver for any signs of enlargement
Evaluate for any abdominal masses

A complete liver function test will be of help to identify the type of jaundice - Hepatocelular/Obstructive.
If hepatocellular, patient will need evaluation of Viral Hepatitis and Autoimmune Hepatitis
USG Abdomen is require to image the Liver and Biliary Tract. It will also help to assess if there is any obstruction of the biliary tract

Hope this answers your query

Thanks And Regards

Dr Kiran
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