Gold Standard for Diagnosis an MI

[Disinence2]

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Hey All,

I've been hearing some conflicting statements between some of my classmates about what the USMLE thinks is the best way to diagnose an acute MI.

Apparently kaplan q bank says one thing, and goljan says another.

What do you all think? ECG? Enzymes? Whats most specific/sensitive? How does time frame factor into all this.

Thanks,

 

[Depakote]

Hey All,

I've been hearing some conflicting statements between some of my classmates about what the USMLE thinks is the best way to diagnose an acute MI.

Apparently kaplan q bank says one thing, and goljan says another.

What do you all think? ECG? Enzymes? Whats most specific/sensitive? How does time frame factor into all this.

Thanks,

had this discussion with a friend via email... copy/pasting my response to him:

My understanding:

An EKG is specific but not sensitive. If you see EKG changes, you've got an MI, but a normal EKG doesn't rule out MI. Troponins are good because they'll show up early and hang around. CK-MB is good because it goes away first (allowing you to dx re-infarction).

The only definitive way to r/o MI is to do serial troponins over a span of 12 hours. If they don't elevate by then, you don't have a MI.

 

[Depakote]

to elaborate on the above

acute EKG changes would show up first, but you can't rely on a negative EKG to mean you're in the clear. You need to do serial troponins which will become positive around 2-4 hours post-MI, that's probably your gold/standard test.

but a lot of that comes down to how the question is worded.

 

[Disinence2]

Sounds good to me!

Thanks for your help

 

[ZagDoc]

acute EKG changes would show up first, but you can't rely on a negative EKG to mean you're in the clear. You need to do serial troponins which will become positive around 2-4 hours post-MI, that's probably your gold/standard test.

Agreed. I doubt a question would be asked where both ECG and troponins are a possible answer. The question will most likely be either "Pt presents with substernal chest pain. ECG shows ST segment elevation in leads x. What is the best test you can order to confirm diagnosis?" or "Pt presents with substernal chest pain. Blood draw demonstrates elevated CK, troponins. What is the best test to confirm diagnosis?"

 

[Re3iRtH]

Agreed. I doubt a question would be asked where both ECG and troponins are a possible answer. The question will most likely be either "Pt presents with substernal chest pain. ECG shows ST segment elevation in leads x. What is the best test you can order to confirm diagnosis?" or "Pt presents with substernal chest pain. Blood draw demonstrates elevated CK, troponins. What is the best test to confirm diagnosis?"

I wish it were that easy 😀 At least UW is not even close to that.