Say... angina

[scudrunner]

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How do you say angina?

I've heard it pronounced two ways, here is my best attempt at spelling them phonetically, but I'm sure you know what I'm talking about:

1) anj-EYE-nuh

and

2) AN-jin-uh

I've heard there is a regional difference, but I've encountered people saying it both ways here in MI. Is there a more popular version?

 

[Gas]

Second one. First one sounds too close to vagina.

 

[Bond8204]

http://dictionary.reference.com/browse/angina

AN-gina is listed as an "often" pronunciation but both audio pronunciations go with "An-eye-na"

 

[coprolalia]

Would you procced with a case if someone presented to the pre-op area with an episode of an-JIH-nuh? Let's say, the case is a knee replacement. Also, say it's a history of stable AN-jeh-nuh, but they didn't take their morning meds because they were told not to by their FP?

Discuss.

-copro

 

[fakin' the funk]

Would you procced with a case if someone presented to the pre-op area with an episode of an-JIH-nuh? Let's say, the case is a knee replacement. Also, say it's a history of stable AN-jeh-nuh, but they didn't take their morning meds because they were told not to by their FP?

What's "their meds," like a nitrate (isosorbide) or whatever that anti-anginal pain med is?

In any case:
ECG
Troponin

If normal/unchanged, we go to OR, as intermediate risk case and no acute cardiac issues.

If abnormal/changed, cancel case as pt in ACS!

 

[Gern Blansten]

What if they had An-Jay-Jay in the Va-Jay-Jay.

 

[Arch Guillotti]

What's "their meds," like a nitrate (isosorbide) or whatever that anti-anginal pain med is?

In any case:
ECG
Troponin

If normal/unchanged, we go to OR, as intermediate risk case and no acute cardiac issues.

If abnormal/changed, cancel case as pt in ACS!

So with one negative set of troponins soon after or during an epsiode of angina you would procedd forward?

 

[coprolalia]

Okay. I'll answer (since there don't seem to be too much interest in this thar thread).

Absolutely don't do this case, even with regional.

Angina is a risk factor, and there's no way to know at this point in time if this patient is converting to unstable angina -> MI. Early EKG is unreliable, as is troponin in the PACU at this time. Plus, you're adding into it the "stress of surgery" to the mix. Other details, in my clinical opinion, are unimportant at this time. Chest pain in a known CAD patient is a absolute DO NOT PROCEED in my book, for whatever reason, for an elective case.

I've seen my fair share of post-orthopedic MI's. Personally, in my book, cancel, call the ED or the cardiologist, work it up. Live to play another day. A knee replacement ain't worth the risk.

$0.02

-copro

 

[Planktonmd]

So let's try to analyze this a little bit:
A guy is asking a question about pronunciation, a simple question and actually interesting.
Suddenly Nancy decides to to interject and impose a clinical question on the guy's thread.
Not only that the clinical question is primitive and lacks the basic structure of a clinical presentation, but also Nancy decides to answer his own question with a clinical pearl from "his book"!
Not only he gives us a pearl but he presents it as a fact of life that we should be so grateful that he enlightened us about it's value.
I find this very annoying, am I the only one who feels this way?

 

[Bertelman]

What's "their meds," like a nitrate (isosorbide) or whatever that anti-anginal pain med is?

In any case:
ECG
Troponin

If normal/unchanged, we go to OR, as intermediate risk case and no acute cardiac issues.

If abnormal/changed, cancel case as pt in ACS!

You don't have any prior troponin to compare.

What if it's nml, you proceed, then they continue to have symptoms in PACU. You check trp again, now it's elevated. Is it a post-op elevation or cardiac?

A single trp number in the setting of chest pain has almost no value unless it is off the chart.

 

[fakin' the funk]

I find this very annoying, am I the only one who feels this way?

You're the only one. Time to go on the ignore list.

 

[fakin' the funk]

You don't have any prior troponin to compare.

What if it's nml, you proceed, then they continue to have symptoms in PACU. You check trp again, now it's elevated. Is it a post-op elevation or cardiac?

A single trp number in the setting of chest pain has almost no value unless it is off the chart.

Fair enough. So I was too much in favor of proceeding with the case. And I kinda forgot the part where we get 3 q6h troponins 😀

So let's tweak the situation a little bit. What about chest pain, in general, in preop holding? What is the appropriate evaluation and disposition toward postponing/cancelling the case?

 

[coprolalia]

You don't have any prior troponin to compare.

What if it's nml, you proceed, then they continue to have symptoms in PACU. You check trp again, now it's elevated. Is it a post-op elevation or cardiac?

A single trp number in the setting of chest pain has almost no value unless it is off the chart.

That's what I'm thinking. It's my practice that chest pain in a patient with known CAD in the pre-op area is an automatic "red card" for an elective procedure, no matter what the circumstances are. The point you make, Bert, is precisely right.

If the guy DOES end-up having an MI and, unfortunately, dies, then that nursing record from the pre-op nurse that said, "patient reports having chest pain in holding" is going to fry you.

This scenario is quite simple. No need to drag it out with a lot of douchey, annoying, mock-Socratic method, "move the target" arguing that is the M.O. of certain posters who need this forum only to inflate their own ego, mollify their self-loathing, and try to vainly increase the value of their pitiful, pointless lives.

-copro

 

[Planktonmd]

Nancy,
The reason you were annoying in this thread is because you asked yourself a question and then answered it!
No one was talking about chest pain pre-op !
Why do you feel that your words of wisdom are so important that you need to hijack a thread to bestow them on us?
On top of that you lack the basic understanding of the subject to a point that you think you made a huge discovery although you are simply stating the obvious.
All this on top of your usual sliminess makes you very annoying. That's all I wanted to say, and this should not hurt your feelings so much because you know it is the truth.

That's what I'm thinking. It's my practice that chest pain in a patient with known CAD in the pre-op area is an automatic "red card" for an elective procedure, no matter what the circumstances are. The point you make, Bert, is precisely right.

If the guy DOES end-up having an MI and, unfortunately, dies, then that nursing record from the pre-op nurse that said, "patient reports having chest pain in holding" is going to fry you.

This scenario is quite simple. No need to drag it out with a lot of douchey, annoying, mock-Socratic method, "move the target" arguing that is the M.O. of certain posters who need this forum only to inflate their own ego, mollify their self-loathing, and try to vainly increase the value of their pitiful, pointless lives.

-copro

 

[Planktonmd]

You're the only one. Time to go on the ignore list.

From reading a few of your recent posts I am very concerned about your understanding of anesthesiology.
Your profile says "resident" although so far you seem to perform at the level of a medical student, or like someone who's only encounter with anesthesia was through reading about it.
Are you a student? or I guess you could be an intern too, but If you are a resident (CA1 or above) then I really think you have a real problem understanding what we do and maybe you need some serious mentoring.
Good luck to you.

 

[ThinkTooMuch]

why are you calling him Nancy?

 

[Planktonmd]

why are you calling him Nancy?

That's his name!

 

[pgg]

I find this very annoying, am I the only one who feels this way?

So far, it looks that way.

For all the petty crap that's getting flung around this forum lately, something clinical - even straightforward stuff like this - is not unwelcome.

 

[pgg]

From reading a few of your recent posts I am very concerned about your understanding of anesthesiology.

[...]

... you need some serious mentoring.

This is great. We're so lucky to have you here, insulting and pissing on everyone who posts without a perfect understanding of anesthesia.


I wonder how many casual student/intern/resident lurkers there are who don't post because the risk of making an error isn't worth dealing with a shovelful of **** from you. You know, people who who over a period of years might become regulars who really add to the clinical discussions here.

You talk about mentoring, but even the most malignant attending I encountered as a resident, the one who still induces stomach clenching and brings an involuntary sneer to my face when I think of that tool, wasn't as obnoxious as you've been lately.


To be honest, I'm losing patience with this place, and your insistence on verbally assaulting and denigrating militarymd and coprolalia in every single thread, +/- a bystander or two, is a big part of it. Not that any of them need my defense, but give it a rest already.

 

[Planktonmd]

You know what?
I am as well sick of your unprovoked attacks and these little bursts of sympathy with these 2 losers!
I have given you the benefit of the doubt on multiple occasions but you seem to insist on going back to this same cocky attitude.
You want to associate yourself with them then be my guest.
If you can read (I doubt it) then you probably would have noticed that I was not the one who started attacking nancy and his master.
On the other hand if you think you can convert this place into some kind of fraternity where you and them keep kissing each other's arses and agreeing on all kinds of backwards ******ed things without anyone being able to argue for fear of your sliminess and silliness, then I will do my best to disapoint you.

This is great. We're so lucky to have you here, insulting and pissing on everyone who posts without a perfect understanding of anesthesia.


I wonder how many casual student/intern/resident lurkers there are who don't post because the risk of making an error isn't worth dealing with a shovelful of **** from you. You know, people who who over a period of years might become regulars who really add to the clinical discussions here.

You talk about mentoring, but even the most malignant attending I encountered as a resident, the one who still induces stomach clenching and brings an involuntary sneer to my face when I think of that tool, wasn't as obnoxious as you've been lately.


To be honest, I'm losing patience with this place, and your insistence on verbally assaulting and denigrating militarymd and coprolalia in every single thread, +/- a bystander or two, is a big part of it. Not that any of them need my defense, but give it a rest already.

 

[pgg]

I am as well sick of your unprovoked attacks and these little bursts of sympathy with these 2 loosers!

Loosers? 🙂

As for "unprovoked attacks" from my quarter, yes, I'm criticizing you here. But you'll note I'm not insulting you, questioning your intelligence, or calling you names. There is a difference.

You may also note that in other threads I'm interested in hearing your opinions. I have no intention of dragging baggage from this thread into unrelated future threads.

If you can read (I doubt it) then you probably would have noticed that I was not the one who started attacking nancy and his master.

Post #9 in this thread - no attacks or criticism until you joined in.

On the other hand if you think you can convert this place into some kind of fraternity where you and them keep kissing each other's arses and agreeing on all kinds of backwards ******ed things without anyone being able to argue for fear of your sliminess and silliness, then I will do my best to disapoint you.

I honestly think you're just missing the point.

In this thread, after seizing/manufacturing an opportunity to go after coprolalia, you came down on a resident (PGY1 I think ... not sure) who was a little overaggressive in not canceling a case.

Your behavior is out of line. Not so far out of line that I want to see the mods step in, but you really are acting inappropriately and the forum is worse off because of it.

 

[dhb]

Okay. I'll answer (since there don't seem to be too much interest in this thar thread).

Absolutely don't do this case, even with regional.

What if she had stable angina, happens with exertion and when she forgets her meds (in this case she rushed a little to the hospital + didn't take her meds) recent workup shows normal EF moderate hypertrophy , diastolic dysfunction etc... cath shows diffuse lesions nothing major to stent or by-pass.

In pre-op she has a normal ECG normal trop , pain recedes after nitro + beta blocker.

Why would you not do it how is she more at risk then the next day or week?

 

[Planktonmd]

So,
You are saying I should not be allowed to express my opinion and say that copro had hijacked a thread for injecting an irrlevant and unrelated point?
And that if I dare doing so I will be disrupting the Forum?
And that If I honestly tell a guy that he has multiple issues with understanding anesthesiology then this is mean and should not be tolerated?
So, If I agree with your point of view would I be good for the forum and not disruptive?
Or maybe I should agree with Copro so I can be considered acceptable on this forum in your distorted view?
I still like to think that I have the right to disagree with whomever i want.

Loosers? 🙂

As for "unprovoked attacks" from my quarter, yes, I'm criticizing you here. But you'll note I'm not insulting you, questioning your intelligence, or calling you names. There is a difference.

You may also note that in other threads I'm interested in hearing your opinions. I have no intention of dragging baggage from this thread into unrelated future threads.



Post #9 in this thread - no attacks or criticism until you joined in.



I honestly think you're just missing the point.

In this thread, after seizing/manufacturing an opportunity to go after coprolalia, you came down on a resident (PGY1 I think ... not sure) who was a little overaggressive in not canceling a case.

Your behavior is out of line. Not so far out of line that I want to see the mods step in, but you really are acting inappropriately and the forum is worse off because of it.

 

[dhb]

you usually do this by PM to avoid further distraction to the thread...

 

[pgg]

You are saying I should not be allowed to express my opinion and say that copro had hijacked a thread for injecting an irrlevant and unrelated point?

If you'd read my previous post I specifically said I did not want to see the mods intervene and censor you.

But you've got to understand that freedom to express an opinion does not include freedom from criticism. No one's infringing upon your rights, trying to shout you down, or get you banned. Settle down.

And that if I dare doing so I will be disrupting the Forum?

You sure managed to disrupt this thread. I'm guilty too, for letting myself get sucked in to this debate.

And that If I honestly tell a guy that he has multiple issues with understanding anesthesiology then this is mean and should not be tolerated?

It's not helpful.

I also question your motives here. You didn't have any altruistic, genuine concern for his "issues with understanding anesthesiology" until you decided that he was on copro's "side" whatever that means. Choosing that particular moment to declare him an idiot was childish and petty.

I still like to think that I have the right to disagree with whomever i want.

Of course you do.

You can behave in any manner you choose. I'm simply suggesting (and I don't think I'm alone here) that you might want to tone it down a bit and, you know, play nice.

Or not. Do what you like.

 

[pgg]

you usually do this by PM to avoid further distraction to the thread...

Yeah, my apologies, I'll stop.

 

[Planktonmd]

Would you promise that you would provide this same advise when Nancy out of the blue accuses someone of being an idiot for not agreeing with him?
It's funny, I did not see you react at any of the multiple occasions when he insulted people!
I did not see you either being such an advocate for others when MMD ripped them a new one for not seeing things his way!
Why aren't you upset that some one like sleepisgood is being continously harrassed by MMD?
Hmmm... Should I say that you seem to have other motives than the well being of the forum and the feelings of others? 😕

If you'd read my previous post I specifically said I did not want to see the mods intervene and censor you.

But you've got to understand that freedom to express an opinion does not include freedom from criticism. No one's infringing upon your rights, trying to shout you down, or get you banned. Settle down.



You sure managed to disrupt this thread. I'm guilty too, for letting myself get sucked in to this debate.



It's not helpful.

I also question your motives here. You didn't have any altruistic, genuine concern for his "issues with understanding anesthesiology" until you decided that he was on copro's "side" whatever that means. Choosing that particular moment to declare him an idiot was childish and petty.



Of course you do.

You can behave in any manner you choose. I'm simply suggesting (and I don't think I'm alone here) that you might want to tone it down a bit and, you know, play nice.

Or not. Do what you like.

 

[ThinkTooMuch]

Its spelled Losers, one O.

 

[2win]

Its spelled Losers, one O.

really?????????

 

[Eta Carinae]

Its spelled Losers, one O.

really?????????

🤣🤣🤣

I Loooooooooooooooooooove this forum!

 

[Planktonmd]

Its spelled Losers, one O.

Thanks 🙄

 

[dhb]

What if she had stable angina, happens with exertion and when she forgets her meds (in this case she rushed a little to the hospital + didn't take her meds) recent workup shows normal EF moderate hypertrophy , diastolic dysfunction etc... cath shows diffuse lesions nothing major to stent or by-pass.

In pre-op she has a normal ECG normal trop , pain recedes after nitro + beta blocker.

Why would you not do it how is she more at risk then the next day or week?

I too shall quote myself.
Back to the clinical?...