What should you call that elevated troponin?This is NOT taught and has important downstream impacts.Understand it in 2 minutes: The problem? Most don't understand how to interpret troponinsMost don't understand the actual definition of an infarctionProper diagnosis (& documentation) ➡️ impacts clinical decisions and quality metricsFirst, pay close attention to the three I-words:InjuryIschemiaInfarctionIt is easy to mix them up and lose track. Pay close attention their distinctions.Two things must be present for an acute Myocardial INFARCTIONAcute myocardial INJURYSigns or symptoms of ISCHEMIA (Notice the *OR* here)Let's break those down.1 / What is myocardial INJURY?Myocardial Injury = Elevated troponin (above 99% upper range limit) ACUTE myocardial injury = A fluctuation of troponins by 20%. Whether this be:A rise of 20% (with at least one elevated) ORA fall of 20% if at least initial was elevatedWhat if elevated but does not change by 20%? Will answer this later.2 / What are Signs & Symptoms of ISCHEMIA?SymptomsAnginaAnginal Equivalents (SOB, diaphoresis, nausea, lightheadedness)**** These symptoms must be documented AS ANGINAL EQUIVALENTS****SyncopeFlash pulmonary edemaPalpitationsCardiac arrestSignsST elevation or depression New flipped T waveNew LBBBNew pathological Q wavesNM stress with new loss of viable myocardium (NOT scar)New ventricular wall motion abnormalityIdentification of coronary thrombus on LHC or autopsy3 / What are the types of INFARCTions?Type 1 (STEMI vs NSTEMI)Acute coronary artery occlusion due to plaque disruption Treatment --> dissolve clot / open blockage(Reminder: Must have Injury + Ischemic signs or symptoms)
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What should you call that elevated troponin?
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What should you call that elevated troponin?This is NOT taught and has important downstream impacts.Understand it in 2 minutes: The problem? Most don't understand how to interpret troponinsMost don't understand the actual definition of an infarctionProper diagnosis (& documentation) ➡️ impacts clinical decisions and quality metricsFirst, pay close attention to the three I-words:InjuryIschemiaInfarctionIt is easy to mix them up and lose track. Pay close attention their distinctions.Two things must be present for an acute Myocardial INFARCTIONAcute myocardial INJURYSigns or symptoms of ISCHEMIA (Notice the *OR* here)Let's break those down.1 / What is myocardial INJURY?Myocardial Injury = Elevated troponin (above 99% upper range limit) ACUTE myocardial injury = A fluctuation of troponins by 20%. Whether this be:A rise of 20% (with at least one elevated) ORA fall of 20% if at least initial was elevatedWhat if elevated but does not change by 20%? Will answer this later.2 / What are Signs & Symptoms of ISCHEMIA?SymptomsAnginaAnginal Equivalents (SOB, diaphoresis, nausea, lightheadedness)**** These symptoms must be documented AS ANGINAL EQUIVALENTS****SyncopeFlash pulmonary edemaPalpitationsCardiac arrestSignsST elevation or depression New flipped T waveNew LBBBNew pathological Q wavesNM stress with new loss of viable myocardium (NOT scar)New ventricular wall motion abnormalityIdentification of coronary thrombus on LHC or autopsy3 / What are the types of INFARCTions?Type 1 (STEMI vs NSTEMI)Acute coronary artery occlusion due to plaque disruption Treatment --> dissolve clot / open blockage(Reminder: Must have Injury + Ischemic signs or symptoms)