Three normal high sensitivity troponins over 4 hours with a " normal ECG "

Written byWilly FrickA 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of " chest burning. " The documentation does not describe any additional details of the history. The following ECG was obtained.ECG 1What do you think?The ECG shows sinus bradycardia but is otherwise normal. There is TWI in lead III, but this can be seen in normal ECGs. No labs were obtained. The patient was given a prescription for albuterol and a referral to cardiology.Smith comment:No patient over 25 years of age with unexplained chest burning should be discharged without a troponin rule out, no matter how normal the ECG.  A diagnosis of " reflux " or " GERD " is never supportable without a troponin rule out.Over the next three days, he continued to have intermittent symptoms and therefore re-presented to the emergency room. He described the symptom as chest burning with occasional radiation into his throat and jaw. He first noticed it while exercising. The day of presentation, the pain woke him from sleep, which is why he decided to come in. The following ECG was obtained around midnight. The machine read was " Normal sinus rhythm, normal ECG. "ECG 2What do you think?Algorithm: GE VU 360Here is the Queen of Hearts interpretation together with lead-by-lead explainability.She sees OMI with high confidence. I sent this ECG to Dr. Smith with no clinical context, and he said " posterolateral OMI. " Just like the Queen of Hearts, Dr....
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs