EBM Smorgasbord

Hey team:

I have mentioned a bunch of articles over these 2 weeks together so this post will provide links to some of the stuff we talked about.  I will provide both a pubmed link where needed and a direct link that requires a UTORID.

1. Thrombolysis in PE:  A useful review from Circulation 2011. As discussed the evidence is debatable in submassive PEs, while for hemodynamically unstable patients the consensus is to thrombolyse. (direct link)

2. Does my dizzy patient have a stroke: Great article from CMAJ on deciding when to order brain imaging for you dizzy patient.  BHig highlight is the type of dizziness is not that useful.

3. Treating hyperkalemia:  Another good review from CMAJ, showing that for acute shift Beta agonists are very helpful.  Remember always to eliminate the excess K, though. 

That's it for today,  watch this space.

"Troponitis": Non ACS causes of increased troponin

Elevation of troponins in the absence of an acute coronary syndrome (ACS) are a commonly encountered issue in ER consultations to GIM.  The two key issues always are:  make sure you exclude an actual ACS and look for an alternative explanation (see long list below).  Simply calling it troponitis relegates it to the background, potentially leading to gaps in care.

To ensure you are not missing an ACS: consider the patients clinical picture and carefully assess the ECG for signs of ischemia. Also repeat the troponin measurement as the trend and magnitude of increase (see figure) relate to the likely etiology.  Very high troponins are indicative of severe myocardial damage from a large MI or myocarditis.
 

Reasons for acutely elevated troponins: Acute coronary syndrome; Acute heart failure; Pulmonary embolism; Stroke; Acute aortic dissection; Tachyarrhythmias; Hypotension /Shock; Sepsis; ARDS; Perimyocarditis; Endocarditis; Tako-tsubo cardiomyopathy; Radiofrequency catheter ablation; Cardiac contusion; Strenuous exercise; Sympathomimetic drugs; Chemotherapy

If you have a utorID look at this REVIEW. Free reviews here and here.