GENERAL MEDICINE

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Investigations

  • ECG : Classical changes are early ST elevation and T-wave inversion followed by Q-wave development.
  • In subendocardial (non Q-wave) infarcts ST depression and T-wave changes only occur.
  • Cardiac enzymes these develop serially: first increases in creatine kinase MB
    (peaks 18-24 h), then aspartate transaminase (peaks 24 h) and lastly lactate dehydrogenase (peaks 3 d). None of the enzymes are specific for MI but the pattern of change is highly suggestive. The peak of the creatine kinase rise correlates approximately with the size of the infarct. Thrombolysis therapy may modify the pattern of enzymes release causing an earlier, higher peak.
  • In cases where doubt exists 99 m Tc-pyrophosphate scanning shows the infarct as a ‘hot spot’.
  • CXR is useful in identifying pulmonary oedema and a proportion of aortic dissections.

 

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