Saliva test for MI diagnosis

[akflightmedic]

http://news.yahoo.com/s/nm/20080421/hl_nm/...heart_attack_dc

Saliva test may speed heart attack diagnosis By Megan Rauscher

Mon Apr 21, 6:25 PM ET

NEW YORK (Reuters Health) - A simple saliva test may one day be used in ambulances, restaurants, neighborhood drug stores, or other places in the community to quickly tell if a person is having a heart attack.

"Proteins found in the saliva have the ability to rapidly classify potential heart attacks," Dr. John T. McDevitt, a biochemist at the University of Texas at Austin, told Reuters Health.

McDevitt and colleagues developed a nano-bio-chip sensor that is biochemically programmed to detect sets of proteins in saliva capable of determining whether or not a person is currently having a heart attack or is at high risk of having a heart attack in the near future.

With the saliva heart attack diagnostic test, a person spits into a tube and the saliva is then transferred to credit card-sized lab card that holds the nano-bio-chip containing a standard battery of cardiac biomarkers. The loaded card is inserted like an ATM card into an analyzer that determines the patient's heart status in as little as 15 minutes.

In a study involving 56 people who had a heart attack and 59 healthy "controls" who did not, "we found that our test could distinguish between heart attack patients and controls with about the same diagnostic accuracy" as that of standard blood tests, McDevitt noted in an interview with Reuters Health.

Many heart attack patients, especially women, experience nonspecific symptoms, or have normal EKG readings, making timely diagnosis difficult, McDevitt explained.

"In our small trial, we had about one third of the patients with these...silent heart attacks on EKG." These patients need to go the emergency department and have their blood drawn and tested for enzymes that are indicative of a heart attack, "which could take an hour to an hour and a half."

The saliva test could be used in conjunction with the EKG and "aid in rapidly diagnosing heart attacks that are silent on EKG," McDevitt said, adding that larger and more refined studies are planned.

[DwayneEMTP]

Does that mean I can stop trying to remember what an inferior wall MI with a righ fascicular block and and lateral ischemia looks like?

Well, thank God for that....

Dwayne

[NCORHI]

15 Minutes?? What if the majority of your transports are under 10?? Seems a bit long. I'll invest more interest when its instant

And of course, what is the cost/benefit?

[Dustdevil]

Ooooh! I like this! As soon as I am done introducing myself -- before I even take vitals -- I'm getting a sputum sample and starting the process. By the time it's done, I will have vitals, a full history and physical, a 12-lead, and oxygen and IV established. At that point, I know whether or not I need to be headed to the cath-lab. Man, no matter how much this costs, it could save millions of dollars a year, and countless lives, as well as a lot of paramedic embarrassment.

Total win! :thumbright:

[JPINFV]

15 Minutes?? What if the majority of your transports are under 10?? Seems a bit long. I'll invest more interest when its instant

And of course, what is the cost/benefit?

On-scene+transport normally is much longer than 15 minutes. Unless you load and go every patient in the extreme sense of not even saying "Hi" before putting the pedal to the metal.

[DwayneEMTP]

My question is this...Ruling out the atypical female STEMI...Is this going to make a huge difference in our treatment?

Again, other than the atypical female STEMI, or even non-STEMI for that matter, by 15 minutes I would hope that I've run through my entire "chest pain" protocol, if the s/s are present, before this test gives me the results I need to make any major decisions...

Here, (CO Springs) significant chest pain with s/s of cardiac involvement go to the cath lab regardless of the ultimate outcome...Perhaps there are more places where this will make a larger difference?

My experience is tiny, so I'm asking that my comments are kept within that scope and not seen otherwise.

I'm not saying that this is not a valuable test, only wondering how it will make a difference in our treatment or transport location decisions with the exceptions mentioned above. Perhaps those are enough...but it's not been my experience.

Dwayne

Edit is for bonehead redundancy...no significant contextual changes made.

[JPINFV]

Pfft, amatures. Call me when they move up to the real test.

[Dustdevil]

My question is this...Ruling out the atypical female STEMI...Is this going to make a huge difference in our treatment?

If your system gives thrombolytics, absolutely! If your system is rural, absolutely! If your 90-day wonder monkey medics are not to be trusted with the diagnosis of who does and does not need AMI protocol application (the majority of the United States), then again, absolutely!

And if this test proves to be a better and more accurate diagnostic tool than current labs, then it is absolutely going to make a big difference for the receiving facility. We cannot fall into the all-to-easy, lazy trap of considering only what happens during our twenty minutes.

[triemal04]

Nice to see technology improving yet again. Although I'm betting it'll be years before this becomes an accepted practise, and longer than that for it to really make it's way to ambulances, it's defiantly another tool that's worth while. (while it's been possible to test for troponin prehospital for years the only place I've heard of it being done is Alaska)

Having another diagnostic tool for atypical or non-stemi's would be great...even if it isn't done prior to arriving at the ER, the wait will still be less than waiting for blood tests to be done. If it allows more systems to implement "cath alerts" and take pt's directly to the cath lab it's another bonus.

Of course, the drawback could be that the need to interpret 12leads could be seen as being diminished...not a good thing. I mean come on, who needs to know what those squiggly lines mean if you've got the spit tester?

I doubt this will be the end-all-be-all for telling if someone is having an MI, but, if it works out with more testing, it'd be another good tool to have.

[Arctickat]

Nice to see technology improving yet again. Although I'm betting it'll be years before this becomes an accepted practise, and longer than that for it to really make it's way to ambulances, it's defiantly another tool that's worth while. (while it's been possible to test for troponin prehospital for years the only place I've heard of it being done is Alaska)

We're using an invitro diagnostic device that provides qualitative results for cTnI, Myoglobin and CK-MB. They are 100% accurate and provide positive results if the trops are over 1.5mcg/ml. It takes about 4 drops of whole blood and gives a result in about 5 minutes. Each cassette costs about 13 bucks, this compared to 16 for the troponin cassette in the ISTAT and the $10,000 for the machine just to get a quantitative reading. Although it isn't as easy as a saliva test, it has come in as useful.