The Curbsiders Internal Medicine Podcast
#451 Acute Coronary Syndrome with Dr. Sanjeev Francis - Part 2
Sep 2, 2024
In this enlightening discussion, Dr. Sanjeev Francis, a cardiologist from Maine Medical Center, dives deep into acute coronary syndrome management. He explains the nuances of stress test warranties and how to tackle elevated troponins in septic patients. The conversation also covers risk stratification, the intricacies of diagnosing myocardial injury, and approaches to non-ST elevation ACS. Through real-life case studies, listeners gain valuable insights on treatment protocols and the importance of patient communication in cardiac care.
01:03:39
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Quick takeaways
- A normal cardiac CT can indicate low coronary event rates but offers a shorter warranty period for patients presenting with chest pain.
- High-sensitivity troponin tests are crucial for diagnosing acute coronary syndrome, guiding management with serial testing for risk stratification.
Deep dives
Importance of Cardiac CT in Risk Assessment
A normal cardiac CT is a valuable tool in assessing the risk of acute coronary syndrome (ACS). A truly normal coronary CT indicates a low event rate for up to ten years; however, for patients presenting with chest pain, the warranty period is closer to two years. It's crucial to understand that while a negative result reduces immediate risk, it does not eliminate the possibility of future cardiac events. Factors such as imaging clarity, patient BMI, and heart rate can affect the accuracy of the test, leading to potential misinterpretations.
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