e-discussion on Emerging trends in therapeutics of ACS

[Guest guest]

Nice pictorial representation of pathophysiology of ACS.

Vijay

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> Dear Members,

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> Heart With Muscle Damage and a Blocked Artery

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> Tarun Wadhwa

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[Guest guest]

Dear all,If we don't have EKG, how can we differentiate chest pain due to ischemic heart disease from other causes?Best,DarithChandarith Cheang, M.D, MPHHospital Improvement Program Team LeaderBHS/URC-CambodiaTel: +855 886977778Skype: chandarithFrom: tarun wadhwa <pharma_tarun@...>Subject: e-discussion on "Emerging trends in

therapeutics of ACS""NetRum" <netrum >Date: Monday, July 18, 2011, 9:19 AM

Dear Members,Differential Diagnosis of Patients with

Chest Pain

I.

Nonischemic cardiovascular o

Aortic dissection o

Myocarditis o

Pericarditis o

Hypertrophic cardiomyopathy o

Stress cardiomyopathy II.

Chest wall/musculoskeletal o

Cervical disk disease o

Costochondritis o

Herpes zoster o

Neuropathic pain o

Rib fracture III.

Pulmonary o

Pneumonia o

Pulmonary embolus o

Tension pneumothorax o

Pleurisy IV.

Gastrointestinal o

Cholecystitis o

Peptic ulcer disease § Nonperforating § Perforating o

Gastroesophageal reflux disease o

Esophageal spasm o Boerhaave syndrome (esophageal

rupture with mediastinitis) o

Pancreatitis V.

Psychiatric o

Depression o

Anxiety disorder/panic attack o

Somatization and psychogenic pain

disorder o

Potentially life-threatening conditionsRegards,Tarun Wadhwa

[Guest guest]

Dear all,If we don't have EKG, how can we differentiate chest pain due to ischemic heart disease fro

[Guest guest]

Dear Dr Viral Shah,Thank you Dr Viral for highlighting such important aspects required while evaluating a case of ACS. These are some of the important points to be remember to avoid misdiagnosis.RegardsTarun WadhwaFrom: Dr.viral shah <viralshah_rational@...>Subject: Re: e-discussion on "Emerging trends in therapeutics of ACS""netrum " <netrum >Date: Monday, 18 July, 2011, 9:43 PM

Nice introductory discussion by Tarun. However, I would like to highlight few words of caution in interpreting pain and ECG in suspected ACS. 1) Never rely on symptoms. Certain characteristic of pain e.g. left side with radiation to arm, has high like hood of having ACS but it neither excludes or includes ACS with certainty. 2) Pain is a symptoms which is highly variable and depend upon the perception/ threshold of a person and never try to judge ACS based on severity of pain. 3) Specific population like old aged and diabetics may not have pain at all and sometimes called silent ACS.

4) Interpretation of ECG is an art which can be learned by experience. ECG may be normal with classical pain of ACS and abnormal ECG without any pain. furthermore, 10% of diabetics may have minor ischemic changes on ECG which are reversible spontaneously with time. Regards,Dr. Viral Shah MBBS, MD, FCCP, DM (running)Senior Resident,Department of Endocrinology,Postgraduate Institute of Medical Education & ResearchSector-12, Chandigarh PIN- 160 012, INDIA.Mobile- 09872308785. Mail: viralshah_rational@... drshahviral@... From: tarun wadhwa <pharma_tarun@...>NetRum <netrum >Sent: Monday, 18 July 2011 8:59 PMSubject: e-discussion on "Emerging trends in therapeutics of ACS" [1 Attachment]

Dear Members,Clinical Presentation:Please find the attached document herewith.Regards,Tarun Wadhwa

[Guest guest]

Dear Members,These are some of the references which i referred for preparation of this session.References

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8. Kumar A, Cannon CP. Acute coronary syndromes:

diagnosis and management, part II. Mayo Clin Proc. 2009;84(11):1021-1036.

9. Schwartz L. Therapeutic options in coronary artery

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Dracup K,

McKinley S, Doering LV et al. Acute Coronary Syndrome: what do patients know? Arch

Intern Med. 2008 May 26;168(10):1049–1054.

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Pham SV, Pham

PT, Pham PT, JM, Pham PT, Pham PT. Antithrombotic strategies in patients

undergoing percutaneous coronary intervention for acute coronary syndrome. Drug

Design, Development and Therapy 2010;4:203-220.Regards,Tarun Wadhwa