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.
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Coronary CT Scan Interpretation
- For a normal coronary CT scan, ensure it's pristine with zero calcium and no plaque.
- Consider the warranty period of 2 years for chest pain ED populations, but remember risk is never zero.
Troponin Use in ACS
- Utilize serial high-sensitivity troponins, checking at 1 and 3 hours or 2 and 4 hours, in ACS evaluation.
- If initial troponins are normal, the event rate is generally low, but not zero.
ACS Risk Stratification
- After diagnosing ACS, employ the GRACE risk score for further risk stratification.
- Higher scores suggest a higher risk, potentially advocating for early coronary angiography within 24 hours.