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q_____________? - sarim
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06-22-2012, 06:50 AM
A 62 y/o man presents with substernal chest pain that occurs with exertion and is relieved by rest.He has been having this on and off for 8 months and the last episode occured 3 days ago while he was running to the bus.He has a hx of well controlled diabetes and dyslipidemia.The vital signs, physical examination, and ECG are normal.An exercise test is done, which shows a 2-mm ST depression.
What's ur Dx? source :kaplan
06-22-2012, 07:50 AM
Sarim i need to find that Question from Kaplan .... but I do believe there is some Subendocardial infarct for St depression to take place. DONT Quote me, someone plz clarify.
06-22-2012, 08:40 AM
"Stable Angina" vs "NON-STEMI"(Non-ST Elevation MI) ????
06-22-2012, 09:10 AM
ischemia is correct, I apologize big time.
this is the Kap Q's which confused me. A 68 old man comes to emergency dept serveral hours of increasing chest pain. He has a history of hypercholesterolemia, diabetes, and angina. Although previous anginal episodes were relieved with sublingual nitro, the patient says nitro has not helped with the pain during this episode. An ECG does NOT show ST- T wave changes, and CK-MB and troponin is normal. Which is the most likely underlying cause of these symptoms? diagnosis: unstable angina (ANSWER : cause is thrombosis with or without underlying atherosclerosis) this patient has unstable angina (ischemia) for hours, yet no ECG changes !!!!, thats why I said need infartion for ECG changes, but Kaplan goes on to say .... unstable angina MAY or MAY NOT be associated with ECG changes, meaning you CAN/ MIGHT have angina (ischemia) without ECG changes!!! ( in the stress test NOW  I Believe it is ISCHEMIA that is causing the ST - depression) but once again Kaplan says angina may or may not have ECG changes.Hope this clears up! please add/ correct me!!!!
06-22-2012, 09:22 AM
general rule:
stable angina - rest no ecg changes, stressed, show st depression unstable- chest pain at rest MAY show st depression, can't stress them. (one platelet away from a massive MI) when stable angina causes subendocardial infarct ECG shows ST- Dep when unstbale angina (if not resolved quickly) causes a transmural infarct ECG shows: STEMI |
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