Thanks for your comments John.
He was 65 years old and a very fit one at that who worked in the building
trade
We did consider an LV anerysm. His CXR was normal but granted he should
have had an echo to exclude/confirm this.
His CK came back at 500 and he had a positive trop T. But again the
question of when he had infarcted remains a mystery
One of my reasons for discussing this chap is that one of my colleagues went
to a cardiology lunchtime meeting where they said something along the lines
of 'if you think they are infarcting then thrombolyse' which I find a bit
scary when the risks of thrombolysis are not so insignificant that one can
give it on gut instinct and ECG criteria.
Any more thoughts?
Sunil
"ORIGINAL MESSAGE"
>We are forever seeing patients with persistent ST segment
>elevation after MIs which are often ventricular anurysm particularly in
>arteriopaths like your chap. I would have searched hard for an old ecg:
>GP
>? Hospital Notes ? CCU ? Previous A&E record ? Of course in another few
>years we would just check his electronic record which he has brought with
>him containing all his medical history and the result of every
>investigation
>he has ever had or if he doesn'nt have it with him we will check it off the
>mirror site which will be kept on teh NHS web ! Near patient testing of
>trop T, myoglobin or CKmb might also be helpful.
>Was I wrong not to thrombolyse him ? Well he didn't infarct did he ? And
>how many 'known arteriopaths' do you know wandering around with virgin
>coronary arteries ? What do you think we would find of we were to angio
>every arteriopath who gets a 5 minute 'niggle' in his chest ? I think what
>is more important here is the changing ECGs
>
>regards
>
>john Ryan
>
>
>
>
>
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