SOURCES OF DIAGNOSTIC AND THERAPEUTIC INACCURACY IN ACUTE CORONARY SINDROMES
Abstract:
A document adopted by a consensus between the European Society and the American College
of Cardiology in 2000, redefines the acute myocardial infarction as any quantity of myocardial necrosis
caused by ischemia. Together with the appearance of new, sensitive biomarkers of myocardial
infarction, little quantities of necrotic myocardium started to be detected and recognized as literally.
The recent definition has changed the diagnosis central role, focusing the attention towards the
troponine levels and lowering the importance of the old criteria (clinical scenery and EKG changes),
allowing a larger scale of interpreting these criteria. Even before been accepted, the new definition of
the myocardial infarction was questioned: only half of the doctors accept the diagnosis in the presence
of the symptoms and the high troponine levels (in the absence of the EKG changes or high levels of CK
and CK-MB). The essential criteria in the fight with the time, regarding the decision of reperfusion,
remains still the ST elevation. Regarding the decision for trombolysis, the EKG changes remain
sovereign. Which doctor had never been confronted in the emergency room with the next situation:
thoracic pain and un-interpretable electrocardiogram? In these particular situations, which can lead to
diagnosis confusions, the interpreting of the troponine elevation can solve some problems. Moreover,
the correct diagnosis of this cases can have serious therapeutic benefits. Even in the case of a correct
and in time diagnosis, the percent of the eligible patients who do not receive any reperfusion form is
unacceptable high (approximate 50%, after the data received from the European Congress 2008). The
aim of this paper is to interpret from this point of view (of the new definition and recent indications of
reperfusion), the data of the patients which were hospitalized during the last two years (January 2007 -
October 2009) in the Cardiology Department of the Emergency Clinical County Hospital, having the
diagnosis at admission of Acute Coronary Syndrome (ACS).
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