elitoki
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Someone can tell me plz...
If ST seg. depression without Q wave is for unstable angina and also for acute subendocardial infarction, how can I differentiate them on first 4 hours before the cardiac enz goes up?
Edited by elitoki on 07/03/07 - 03:30 PM
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| arlete
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You can't.
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| DrVirgo
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elitoki wrote:
Someone can tell me plz...
If ST seg. depression without Q wave is for unstable angina and also for acute subendocardial infarction, how can I differentiate them on first 4 hours before the cardiac enz goes up?
ST segment depression occurs in STABLE (not unstable) Angina.
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| ssrpk
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really then wht happens in unstable angina????
both can present with ST depression, its just the clinical presentation that will differ the two and will guide the therapy.
as for unstable and subendocardial infarction, need not differentiate that so early, as management remains the same, both will require antiplatelets and anticoagulants
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| Aashi
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ssrpk wrote:
really then wht happens in unstable angina????
both can present with ST depression, its just the clinical presentation that will differ the two and will guide the therapy.
as for unstable and subendocardial infarction, need not differentiate that so early, as management remains the same, both will require antiplatelets and anticoagulants
 
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| elitoki
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Thanks everyone. ~
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| arlete
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ST segment depression occurs in both stable and unstable angina.
In Prinzmetal (considered an unstable angina) you have ST segment elevation.
Agree with ssrpk in everything.
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| dr in trouble
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| cirus
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Stable & unstable Angia---> St segment Dep
Differentiate accord to character, at rest or more than 20 min---> Unstable Angina
Myocardial infarc---> 1st EKG---> Hyper T wave
Then ---> St segment Elevation +/- Q waves
If Q wave +ve ( Severe MI) ---> Transmural MI
If Q wave -ve---> Subendocardial MI
If ST seg elevation with young age ---> Stress or anxious --->Prinzmetal Angina
If ST seg elevation with young age + History of Vaculitis -----> Takayaso Synd induced MI
hope this helps
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| DrVirgo
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sorry, i mixed up ST depression in my last post... You all are right...
(Stable and Unstable both can have ST depression).
As for UNSTABLE Angina though, the EKG will not show ST elevation, correct???
But Prinzmetal Angina does show ST elevation.
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| DrVirgo
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I have another question...
Patient presents with chest pain. EKG shows ST Elevation.
ST Elevation indicates transmural ischemia or infarct.
How can we differentiate between:
1. ST Elevation due to an MI -from blocked coronary arteries
versus
2. ST Elevation due to Prinzmetal -coronary artery spasm?
And what is the management?
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| arlete
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Young female patient with low-risk profile for CAD, chest pain that wakes her up in the middle of the night = tends toward Prinzmetal angina, the ST segment elevation will be temporary, treatment with calcium channel block.
Elderly patient with risks = tends towards CA blockage, the ST segment will last long and turn into Q waves if revascularization not reached, treatment with PCA if possible.
You have to order enzymes to differentiate them, do serial EKGs; catheterization is the gold standard for sure.
Remember: ST segment elevation may also indicate previous aneurysm, so if a patient has antecedent of MI and is complaining of recent CP, comparing with an old EKG is very important to distinguish between angina and new MI. Patients with aneurysm should carry an EKG with them because of that (as well as patients with LBBB).
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| dr in trouble
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The gold standard to distinguish between Prinzmetal angina and MI is cardiac catheterization,vessels will be devoid of any thrombus in prinzmetal angina.
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