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ACUTE CORONARY SYNDROME-INVESTIGATION

Cardiology

ACUTE CORONARY SYNDROME-INVESTIGATION

1. Troponin I and troponin T (cTni and cTnT), are now the gold standard for the detection of myocardial necrosis.

2. Troponins first become elevated at 4 hrs following an MI and peak at about 44 hours after the event, remain elevated for 10-14 days.

3. Can also be elevated in chronic renal failure, myopericarditis, HF, sepsis, pulmonary embolism, and cardiac trauma, RV strain.

4. CKMB is specific to myocardium, becomes detectable at 3-12 hrs following Ml and peaks at 24 hours. Returns to normal range after 48-72 hours, earlier than troponins.

5. Myoglobin is a sensitive, nonspecific - rises very rapidly, so a negative myoglobin in the first few hours is useful in
ruling out an infarction (high negative predictive value). Returns to normal within 24 hrs.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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