Tuesday, January 15, 2019

Infection & MI

PulmCrit (EMCrit)
PulmCrit - January 14, 2019 - By Josh Farkas 
"Summary The Bullet:
  • Myocardial infarction can be caused by any source of physiologic stress. Infection is no exception to this rule.
  • Myocardial infarction can be commonly diagnosed among patients with acute infection. However, most of these patients likely have type-II MI (demand ischemia), which doesn’t mandate specific therapy (e.g. anticoagulation, cardiac catheterization).
  • For patients presenting with infection, appropriate screening tools to look for myocardial ischemia include a history, physical examination, and EKG. If these tests reveal no evidence of ischemia, there is no indication to check a troponin.
  • Allow me to repeat this for emphasis: Neither influenza nor pneumonia are indications to check a troponin level.
  • Aggressively screening every influenza patient with a troponin will only degrade the positive predictive value of the test, leading to lots of false-positive results. This may trigger a cascade of inappropriate therapies (anticoagulation, beta-blockade, cardiac catheterization) with iatrogenic harm."