![]() 1. Sensitivity and specificity of treadmill, echo, and myocardial perfusion stress testing: * Treadmill Sn: 68%, Sp 77%. * Dobutamine Stress Echo: Sn 81%, Sp 80%. * Myocardial Perfusion: Sn 87%, Sp 73%. 2. 50% of the plaques that rupture and cause AMI/ACS are <50% stenoses, and are generally not detected on stress testing. A NEGATIVE STRESS TEST DOES NOT RULE OUT ACS! * For this reason, if the clinical history is concerning, no prior stress test should be reassuring, regardless of how recent. 3. AHA recommendations on stress testing are based on "very limited" evidence. Particular populations where utility is limited: * Patients <40 years old. * Patients with recent (last 14 days) cocaine use. Journal of EM 2004 (Littmann) - All stress tests were positive, but all of their caths were normal. Deemed false positive stress test for up to 2 weeks.
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![]() Some Thoughts to Keep in Mind
Calcium Score
![]() BASICS
DIAGNOSIS
SIZE MATTERS
MANAGEMENT
Always beware of diagnostic momentum!
Young age alone does NOT rule out ACS Very Low risk patients are defined and may be D/C'd with no further ED evaluation
Non-specific ST changes are NOT negligible in the symptomatic patient. PITFALL: Placing too much emphasis on "atypical" symptoms for ACS Things that Increase Likelihood Ratio for ACS/MI
NO Studies risk-stratify patients to NO risk. Characteristics of pts D/C'd with missed MI
Know your ECGs! You need to strive to be the ECG Master in your hospital! So invest some time and effort into it... Learn from the best: http://www.mededmasters.com/ecg-lessons-by-amal-mattu.html Complications of Zoster
Indications for Treatment
Medical Management
Pediatric myocarditis Background
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