We recently moved to hs-trops in my system. The HEART score uses multiples of a normal troponin to determine a score. What do you use as the upper limit of normal? 99th percentile? Those values are different for men and women. The delta between values is also important, both up and down, with hs-trops.
We are doing a BIG review on this to add to the CorePendium chapter, we will report on this. In the mean time take a look at this segment on the topic: https://www.emrap.org/episode/emrap2020june/cardiology
Thought H was history as well as clinical acumen and gestalt . New onset angina is the fear when it is not classical . Shortness of breath on walking more tiredness on exertion and non chest pain pain on exertion emotion after a big meal walking in the cold or pain after sex . The Troponin's might not be elevated and the ECG non- specific or stone cold normal annoyingly . Pain discomfort ill at ease on exertion is a clue to fear .
I'm having a hard time parsing the primarily literature to find an answer to this. Do inverted T waves count as repolarization abnormalities when applying the heart score? What if they are chronic?
This is a good question here is a current definition of non-specific T Waves - hold your breath:
no ST-J depression ≥0.5 mm but ST-segment downward sloping and ST-segment or T-wave nadir at least 0.5 mm below the P-R baseline, in any of leads I, II, aVL, or V2 to V6 (MC 4-3); ST-J depression ≥1.0 mm and ST-segment upward sloping or U-shaped, in any of leads I, II, aVL, or V1 to V6 (MC 4-4); T-wave amplitude zero (flat), negative, or diphasic (negative–positive type only) with <1.0-mm negative phase in leads I, II, V3 to V6, aVL when R-wave amplitude is ≥5.0 mm (MC 5-3); and T-wave amplitude positive and T- to R-wave amplitude ratio of <1:20 in any of leads I, II, aVL, or V3 to V6 when R-wave amplitude in the corresponding leads was ≥10.0 mm (MC 5-4).
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Timothy P. - November 4, 2022 1:42 PM
We recently moved to hs-trops in my system. The HEART score uses multiples of a normal troponin to determine a score. What do you use as the upper limit of normal? 99th percentile? Those values are different for men and women. The delta between values is also important, both up and down, with hs-trops.
Thoughts?
Mel H. - November 5, 2022 11:12 AM
We are doing a BIG review on this to add to the CorePendium chapter, we will report on this. In the mean time take a look at this segment on the topic: https://www.emrap.org/episode/emrap2020june/cardiology
Ian L. - November 5, 2022 8:10 PM
Thought H was history as well as clinical acumen and gestalt .
New onset angina is the fear when it is not classical .
Shortness of breath on walking more tiredness on exertion and non chest pain pain on exertion emotion after a big meal walking in the cold or pain after sex .
The Troponin's might not be elevated and the ECG non- specific or stone cold normal annoyingly .
Pain discomfort ill at ease on exertion is a clue to fear .
James C. - February 24, 2023 5:21 AM
I'm having a hard time parsing the primarily literature to find an answer to this. Do inverted T waves count as repolarization abnormalities when applying the heart score? What if they are chronic?
Mel H. - February 24, 2023 12:30 PM
This is a good question here is a current definition of non-specific T Waves - hold your breath:
no ST-J depression ≥0.5 mm but ST-segment downward sloping and ST-segment or T-wave nadir at least 0.5 mm below the P-R baseline, in any of leads I, II, aVL, or V2 to V6 (MC 4-3); ST-J depression ≥1.0 mm and ST-segment upward sloping or U-shaped, in any of leads I, II, aVL, or V1 to V6 (MC 4-4); T-wave amplitude zero (flat), negative, or diphasic (negative–positive type only) with <1.0-mm negative phase in leads I, II, V3 to V6, aVL when R-wave amplitude is ≥5.0 mm (MC 5-3); and T-wave amplitude positive and T- to R-wave amplitude ratio of <1:20 in any of leads I, II, aVL, or V3 to V6 when R-wave amplitude in the corresponding leads was ≥10.0 mm (MC 5-4).