SPAM the Troponin

Significant troponin elevation in MI is when it’s level is above the 99th percentile of normal upper limit. There are few causes of elevated troponin which i summarized with the mnemonic SPAM

S: Severe Chronic Kidney Disease

P: Pulmonary Embolism

A: Aortic dissection (especially involving right coronary artery causing secondary MI.

M: Myopericarditis

Elevated troponin in pulmonary embolus patient associated with higher mortality rate. Severe CKD cause chronic mild to moderate troponin elevation.

The ABC of ST Elevation (Differential Diagnosis)

Just to share my mnemonic for the causes of ST elevation. Moral of the story is that, not all ST elevation equals to acute myocardial infarction.

The Mnemonic is "ABCD HELP ”

A- Acute myocardial infarction

B- Brugada Syndrome

   - Benign Early Reploarization

C - Carditis

D - Disease of the CNS system

H - Hypothermia

E- Electrolyte (Hyperkalaemia)

L- Left ventricular hypertrophy

   - Left bundle branch block

   -Left ventricular aneurysm

P - Prinzmetal angina

   - Post Electrical cardioversion

The ACE Inhibitors Study in Angina

 

Source: Scottish Intercollegiate Guidelines Network, Management of stable angina A national clinical guideline, February 2007

Grades of Recommendation: All patients with stable angina should be considered for treatment with angiotensin converting enzyme inhibitors.

Conclusion: ACE inhibitors significantly reduced all cause and cardiovascular mortality

HOPE Study

involved 9,297 high-risk patients with vascular disease or diabetes plus one other cardiovascular risk factor without history of heart failure or left ventricular dysfunction

Ramipril was associated with significant reductions in all-cause mortality, myocardial infarction and stroke in these patients

EUROPA Study

use of perindopril in the EUROPA study involving 13,655 patients with stable coronary disease and no clinical evidence of heart failure reduced the risk of cardiovascular death, myocardial infarction or cardiac arrest

significant reduction in cardiovascular events is mainly due to the reduction in the incidence of non-fatal myocardial infarction

The effect on all-cause mortality did not reach a statistically significant level. Subgroup analysis of the trial showed that benefit from perindopril is mainly in patients with history of myocardial infarction

PEACE trial

using trandolopril of 8,290 patients with no history of clinical heart failure or echocardiographic evidence of left ventricular systolic dysfunction did not reveal any benefit on cardiovascular events although the event rate was unexpectedly low

QUIET Study

1,750 patients with coronary heart disease and normal left ventricular function found that the ACE inhibitor quinapril did not significantly affect clinical outcomes or the progression of coronary atherosclerosis