In article <000f01c0f5f6$fd282380$f4387ad5@afogarty>, Adrian Fogarty
<[log in to unmask]> writes
>----- Original Message -----
>From: "Sam Waddy"
>> New onset angina therefore unstable. So admit, fragmin, aspirin, 12
>> hourly troponin (if the above wasn't) assuming no further chest pain,
>> troponin not diagnostic for MI then exercise test, if negative home,
>> follow up in 6 weeks, if positive keep as in patient, continue aspirin,
>> fragmin, beta blockade, await inpatient angiogram. Probably start a
>> statin as well.
>> At least that is what I would do as a medical SHO.
>> Sam Waddy
>
>Bullshit, new onset does not automatically mean unstable; this is stable
>angina and even stable angina has to have an "onset" sometime!
>Adrian Fogarty
I agree that SOME of these patients will indeed be their first
presentation of "stable" angina, but some of them it will be unstable
angina...thinking about the biology of this there is no way we can tell
on a single episode whether her stable atheroma has now reached a
critically narrow stage or whether she had a small plaque rupture this
morning and formed a clot which she then lysed...if it is the latter
then she is at extremely high risk of having an infarct later on today
or in the near future. The only way of ensuring this woman has an
exercise test to assess that risk is to admit her. Also you need to do
at least a 6 hour troponin if not a 12 if you do one at all otherwise it
will be a falsely reassuring test.
--
Sam Waddy
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