Acute coronary syndrome: unstable angina and non-ST segment elevation myocardial infarction

elevated troponin indicate myocyte damage irrespective of CAUSE. the
cause could be unstable angina or full-fledged myocardial infarction or
any non-cardiac case as cited.it is also a question of degree of
positivity. low levels of markers quantitatively will be seen in
myocardial necrosis, but high in infarction. a patient with negative
troponin excludes a myocardial infarction.
a simple way of correlating positive troponin is combining it with cpk-mb.
when both troponin and cpk-mb are positive it indicates myocardial
infarction. if troponin is positive with negative cpk-mb it is myocardial
necrosis.

? role of antibiotics in ua/nsremi

in the etio-pathogenesis of atheroma clamydia , helicobacter and CMV have been
implicated. instability of plaque may be triggered by the same. fringe literature have
mentioned role of antibiotics especially macrolides.certain pilot treatment trials
suggest that chlamydia pneumoniae may be a potentially treatable cause of ua.
(roxis pilot study, academic study) of course, the standard treatment for ua are as
outlined in this article. when high risk patients are identified, they are triaged for
pci. however, this is not always possible in our practice here. the patients may
have to undergo long journeys to a cath lab, also it is often not affordable.when
patients do not stabilise and we have exhausted our armamentarium like aspirin,
clopidogrel, nitrates, lmwh, ca+ blockers, beta-blockers, trimethadazine and
nicorandil, we often add a macrolide.

Competing interests:  
None declared