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The Curbsiders Internal Medicine Podcast

#451 Acute Coronary Syndrome with Dr. Sanjeev Francis - Part 2

Sep 2, 2024
Dr. Sanjeev Francis, a cardiologist from Maine Medical Center, delves into acute coronary syndrome in this informative discussion. He reveals the 'warranty' concept for stress tests and how to properly manage non-ST elevation ACS. The conversation emphasizes risk stratification and the role of elevated troponin levels, especially in cases of sepsis. Dr. Francis also discusses innovative management strategies for hyperlipidemia and the significance of personalized medical treatments in optimizing patient outcomes.
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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