AIIMS Delhi NO- 2019
Medical & Surgical Nursing
Easy
A patient was brought to ED with complaint of chest pain from last 1 hour. Which test is done to detect myocardial infarction?
Appeared in: AIIMS Delhi NO- 2019
Explanation
- Troponin T is a cardiac-specific protein that is a component of the contractile apparatus of heart muscle cells.
- Following myocardial injury or necrosis, as occurs in a myocardial infarction, these proteins are released into the bloodstream.
- Elevated levels of cardiac Troponin T (cTnT) are highly sensitive and specific for myocardial damage, making it the preferred biomarker for diagnosing MI.
- Blood levels of troponin begin to rise within 2-4 hours of symptom onset and can remain elevated for up to 14 days, providing a wide diagnostic window.
Why Other Options Were Wrong
- Option A: Checking serum electrolytes (like potassium, sodium, and calcium) is crucial for monitoring and preventing cardiac arrhythmias, which are a common complication of MI. However, electrolyte levels do not diagnose the heart muscle damage itself.
- Option B: An Arterial Blood Gas (ABG) analysis measures the oxygen and carbon dioxide levels and the pH of the blood. It is used to assess a patient's respiratory and metabolic status, not to diagnose an MI.
- Option C: A Complete Blood Count (CBC) measures different components of the blood. While the white blood cell count may become elevated as an inflammatory response to the necrotic heart tissue after an MI, this is a non-specific finding and is not used for diagnosis.
Related Visual
- No visual required for this question type.
Clinical Relevance
- Nursing practice connection: Use the key finding related to Diagnosis of Myocardial Infarction using cardiac biomarkers to guide bedside assessment, documentation, and the next nursing action.
- The nurse's primary role in a suspected MI is to ensure rapid assessment, obtain an ECG, and draw blood for cardiac biomarkers STAT as per protocol. Time is muscle.
- Serial troponin levels are often drawn (e.g., at presentation, 3 hours, and 6 hours) to observe the trend, as a rise and/or fall in values is diagnostic of an acute event.
- Patient education is vital. The nurse should explain the purpose of the frequent blood draws to the patient and family to reduce anxiety and ensure cooperation.
How to Approach the Question
- First, identify the key elements of the question: a patient with acute chest pain and the need for a diagnostic test for myocardial infarction (MI).
- The question asks for the specific test to detect the MI.
- Review the options. Think about the primary purpose of each test.
- Serum electrolytes are for monitoring rhythm risk. ABG is for oxygenation/acid-base status. CBC is a general screen for blood cell counts.
- Recall that MI is defined by the death of heart muscle tissue.
- Connect this pathophysiology to the diagnostic tests. The death of heart cells causes them to release their internal contents. Troponin is a protein specific to heart muscle.
Concept Tested & Keywords
- Concept Tested: Diagnosis of Myocardial Infarction using cardiac biomarkers.
- Stem keywords: chest pain, myocardial infarction, detect, test
- Lead-in keywords: Which test
- Clinical cues: Patient with chest pain for 1 hour, presenting to the ED, which suggests an acute event requiring rapid diagnosis.
Question ID
QRZP5C-QUS9jGFAXmuZYQQ
Reference Book
E6 PATHOLOGY QUICK REVIEWBased on Harsh Mohan Textbook of PATHOLOGY p. 196-198
E6 Pathology-Textbook of PATHOLOGYHarsh Mohan Part 2 (215-514) p. 9-11
E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 553-555
Practise the full AIIMS Delhi NO- 2019
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