85 year old with chest pain, STEMI negative, then normal troponin but with relatively large delta: discharge?

Conclusion:This patient should NEVER have been ruled out by troponin.And the ECG findings, which are diagnostic of OMI, were also missed.Thus, this is the protocol Fred Apple and I developed for Hennepin for the Abbott Architect:==================================My Comment by KEN GRAUER, MD (3/24/2023):==================================I like this case by Dr. McLaren — because it allows us to highlight a very important fault of the outdated STEMI paradigm that is all-too-often forgotten — namely, Being sure to obtain and clinically correlate at least 2 serial ECGs before you send the patient home! (with " clinical correlation " meaning lead-by-lead comparison of these serial ECGs — keeping in mind the presence and relative severity of CP at the time each ECG was obtained). For ease of comparison in Figure-1  — I’ve reproduced the first 3 ECGs that were done in today’s case.In reviewing events transpired in today ' s case — Obtaining a 2nd ECG and clinical correlation of symptom severity with each ECG that is recorded before discharging the patient was clearly not done on this patient ' s 1st visit to the ED (Emergency Department). I say this because:Considering that today ' s patient presented with new CP (Chest Pain)  — the initial ECG is already diagnostic of an acute event&nb...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs