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The return of food and liquids back up your esophagus, also called regurgitation. Gibson, C.M. Medication adjustment resulted in resolution of nocturnal symptoms, which were likely a manifestation of GERD and angina. SURAJ A. ACHAR, M.D., SURITI KUNDU, M.D., AND WILLIAM A. NORCROSS, M.D. Swinkels, B.M., et al., Prevalence and clinical significance of an elevated cardiac troponin I in patients presenting to the Emergency Department without chest pain. Although protocols for chest pain units may vary somewhat, one protocol28 that has been shown to be safe and cost-effective in an intermediate-risk population consists of the following: 1. WebElevated troponins New or presumably new ST-segment depression High-risk findings on noninvasive stress testing Depressed LV function Hemodynamic instability Sustained V-tach PCI within previous 6 mo Prior CABG Management Dual antiplatelet therapy and antithrombotic therapy is mainstay of treatment The magnitude of an ECG abnormality affects diagnostic accuracy. Can Troponin Be Elevated Without Heart Attack In patients with acute coronary syndrome with elevated cTnI and insignificant coronary artery disease, the possibility of coronary vasospasm as a cause of elevated cTnI should be considered. Januzzi, Jr., Clinical applications of highly sensitive troponin assays. However, the CK-MB subform assay is not yet widely available. Symptoms of acute myocardial ischemia such as typical chest pain. Ominous physical findings include a new mitral regurgitation murmur, hypotension, pulmonary rales, a new third heart sound (S3 gallop), and new jugular venous distention. Apple, F.S., et al., Predictive value of cardiac troponin I and T for subsequent death in end-stage renal disease. 11th ed. When used by trained physicians, the Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (a computerized, decision-making program built into the electrocardiogram machine) results in a significant reduction in hospital admissions of patients who do not have acute coronary syndrome. Morrow, and P. Jarolim, Earlier detection of myocardial injury in a preliminary evaluation using a new troponin I assay with improved sensitivity. However, there are also many mechanisms of myocardial injury unrelated to reduced coronary artery blood flow, and these should be more appropriately termed non-MI troponin elevations. The silent myocardial infarction hypothesis is based on the relatively high incidence of ischemic changes noted on screening ECGs in patients with diabetes. Bastiany A, Pacheco C, Sedlak T, Saw J, Miner SES, Liu S, Lavoie A, Kim DH, Gulati M, Graham MM. J Am Coll Cardiol. R. Salvador, T. J. Watson, F. Herbella et al., Association of gastroesophageal reflux and O2 desaturation: a novel study of simultaneous 24-h MII-pH and continuous pulse oximetry, Journal of Gastrointestinal Surgery, vol. Patients with all three of these features have a greater likelihood of having acute coronary syndrome than patients with none, one, or even two of these features. During the hospitalization, the patient had another episode of nocturnal dyspnea with chest tightness. Cardiac catheterization revealed chronic three-vessel coronary artery disease, with 2 patent grafts and 2 chronically occluded grafts. Bethesda, MD 20894, Web Policies He also denied any nausea, vomiting, or epigastric discomfort.