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doc_friend_india Forum Junior Topics: 16 Posts: 34	Dec 04, 2004 - 10:54 AM       #1 late complications of myocardial infarction (mi) : dressler's syndrome , shoulder hand syndrome . ... what are these? what is thallium -201 radioactive imaging for mi? what makes raised homocysteine serum levels a risk factor for mi? why is there leucocytosis in mi? what is the role of laxatives in mi?
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ELM Forum Guru Topics: 28 Posts: 932	Dec 04, 2004 - 11:21 AM       #2 Never heard that shoulder hand syndrom...beats me! ...anyone have any idea? Dressler's Sx occurs after MI about 6 weeks due to an autoimmune phenomenon ...it's a fibrinous restrictive pericarditis! Homocysteine----> endothelial damage---> clot formation---->MI Laxatives---> Met alkalosis---> conduction dysturbancies---->MI Leucosytosis <---- necrosis <----tissue death <---MI Thallium -201 scan ----> to look for damaged myocytes <----MI PS: it's not same test as Angina Thalium test!!!! Be ware of these two!!
doc_friend_india Forum Junior Topics: 16 Posts: 34	Dec 04, 2004 - 11:28 AM       #3 thx elm
miky Forum Senior Topics: 16 Posts: 99	Dec 05, 2004 - 2:57 AM       #4 Dear ELM, Laxatives---> Met alkalosis---> conduction dysturbancies---->MI Let me not agree with that. :shock: You should give mild laxatives to a person who had a recent heart attack - severe straining can do much damage to a person with a MI :wink: . Most doctors actually chose to give a mild laxative for a better transit and to avoid constipation (in most situations, constipation occurs as a result of long - term staying in bed) Leucosytosis <---- necrosis <----tissue death <---MI Not always ! - If the infarction is small or if you have a good coronary collateral circulation, you may never find leukocytosis :wink: . Thallium -201 scan ----> to look for damaged myocytes <----MI That's a good one :lol: !!!. In the name of all patients with medical insurance, how many of them can actually afford such an investigation? :shock: . It's very expensive, not routinely ordered and done and sth more - it's done retrospectively - it's not done during an attack :idea: !. It's done after the heart attack, if pt. can afford it :!: . Besides, that's the last investigation I would think of in a pt. with heart attack. I would first make sure that the pt. does not die suddenly (fatal arrhythmias) or does not develop cardiogenic shock :wink: . Once the pt is stabilized and out of immediate danger, I would think of radionuclide scan 8) . My opinion.
ELM Forum Guru Topics: 28 Posts: 932	Dec 05, 2004 - 6:51 AM       #5 Hi miky! I understand your reasonings! But laxatives cause conduction dysturbancies through met alkalosis...it's big time cause of diffirent bad arrhthmias ---->MI! I don't conflict with you reasoning of laxative use AFTER MI! So if you have any reasons that why laxatives doesn't cause conduction dysturbancies please let me know....becuase you said you disagree with that....it's written all over the books...i don't see why it could be wrong! Secondly....she asked what is the cause of Leucocytosis in MI....she didn't intersted in if it's present in 100% times or such...so if you disagree with tissue death and necrosis cause leucosytosis...then what is it? Why there is leucocytosis at all in MI? That's what she would liked to know! Then again...thallium-201 she wanted to know what is it! This girl/guy pm-d me and said she was 3rd year med school student just starting clinicals...so she wanted to get some ideas above asked stuff. She wanted to know what is it and why is it!!!! Please take your time and read the qs before you say DISAGREE! Thank you!
mdwannabe Forum Guru Topics: 37 Posts: 1131	Dec 05, 2004 - 2:39 PM       #6 If I can just a make a comment here.... conduction disturbances do not lead to MI...rather it is MI that leads to conduction disturbances. Leucocytosis is almost always present in any MI...if collaterals are present you simply don't get MI..only some ischemic changes on ECG. The reason for leucocytosis is same as everywhere..release of inflamatory mediators...and cortisol...that demarginates white cells. Thalium scan...does not look for myocytes..it looks for accumulation of radioactive dye in areas of heart...the less accumulation...the less perfusion...the higher susp of ischemia. As far as rest of the comments go... I ll just stay out of it. You guys can slugg it out.
miky Forum Senior Topics: 16 Posts: 99	Dec 05, 2004 - 3:47 PM       #7 I see that you take everything too serious . Relax a bit. You are a doctor, for patients' sake . I just expressed my opinion :shock: . Don't I have this right :shock: ? Ya, I realized that the poor guy was just a med student, but I gave a polite and argued answer :idea: . I did not insult you :idea: . As for MI, you can develop MI even if you have good collaterals, but it will be asymptomatic in most cases. You may also develop a serious trifascicular MI, which can be more clinically allert :wink: . Leukocytosis is present only if serious attack (a considerable portion of heart muscle is involved). It's true that you see PMNs gathering in the infarcted area, but that does not necessarily implies that you must also see increased WBC count in the peripheral blood. Take Diabetes mellitus for instance - they hardly mount a good immunological response to an infection (you know why), so they may not have leukocytosis :wink: . Hope that the poor student will forgive me :cry: . :roll:
doc_friend_india Forum Junior Topics: 16 Posts: 34	Dec 06, 2004 - 12:12 AM       #8 thanks to all of you ... i think i will benefit from all your experiences ... yes i am just a third yr student yet ... so many basic doubts ... sorry if it has triggered the argument :cry:
mdwannabe Forum Guru Topics: 37 Posts: 1131	Dec 06, 2004 - 7:31 AM       #9 why are you sorry???? I am a 3rd year too... and almost never sorry to spark an argument. The truth comes out of the struggle of minds :-) Keep it up! Cheers! :-)
Dot Forum Senior Topics: 1 Posts: 168	Dec 07, 2004 - 4:08 AM       #10 :wink: sorry to interrupt in ur argument I wanted to say that the perfusion scan is costly and it also doesnt differentiate weather the infract is old or new, but it shows abnormal wall movements which is helpful in immidiate t/t if mi is assoc. with normal st segment on ecg
ELM Forum Guru Topics: 28 Posts: 932	Dec 10, 2004 - 6:38 PM       #11 Hi doc_friend_india! I was reading some stuff today and came acrossed about Shoulder hand Sx that you asked...thought i would share with you. It's called Reflex symphathetic dystrophy or Causalgia, presents with pain and loss of function without clear cut sensory or motor deficits and it's a localized autonomic impairment. Could occur after MI, some trauma and limb paralysis. If you ask you get answers.....it's good! Good luck to you!
doc_friend_india Forum Junior Topics: 16 Posts: 34	Dec 21, 2004 - 5:31 AM       #12 thanks elm ....
mariam Topics: 7 Posts: 35	Dec 27, 2004 - 7:28 PM       #13 hi i noticed u saying that thallium-201 scan is different from angina thallium test.. how is that? what is the diff between both thank u

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