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Title: Serum, urine and electrocardiographic changes in the diagnosis and differentiation of Q-wave and non Q-wave myocardial infarction
Author: Kelly, Paul Antony
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1995
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Thrombolytic therapy (TT) significantly reduces mortality and morbidity following acute myocardial infarction (AMI). This is presumed to be secondary to reperfusion of the infarct related artery. Increased use of TT has produced a requirement for early, accurate diagnosis of AMI. Not all patients show equivalent benefit to TT; consequently, the management of patients post-AMI is likely to become increasingly varied. There is a need for non-invasive assessment of arterial patency to identify patients in whom myocardium remains at risk. To compare 4 recognised biochemical markers, creatine kinase-MB (CK-MB), mass and activity, myoglobin and troponin-T to serum and urinary creatine concentrations in the diagnosis and differentiation of AMI, and the non-invasive assessment of arterial patency following thrombolysis, 191 patients admitted to a coronary care unit with a differential diagnosis of AMI were studied. On the basis of the admission electrocardiogram (ECG), they were divided into the following groups: Group A: Admission ECG diagnostic of AMI (n=56) Group B: Admission ECG non-diagnostic of AMI but AMI proven at day 3 (n=48) Group C: Admission ECG non-diagnostic of AMI, and AMI excluded at day 3 (n=87) Type 1: Q-waves on day 3 ECG (n=58). Type 2: No Q-waves on day 3 ECG (n=46). Serum or urine creatine concentrations are not useful diagnostic markers for AMI CK-MB mass and activity, myoglobin and troponin-T are all highly sensitive and specific in AMI diagnosis, troponic-T having an advantage over CK-MB activity and myoglobin. Myoglobin provides the earliest diagnosis of AMI, and the most rapid biochemical indication of reperfusion following thrombolytic therapy.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available