Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

Conclusions When high sensitivity cardiac troponin testing is performed widely or without previous clinical assessment, elevated troponin concentrations are common and predominantly reflect myocardial injury rather than myocardial infarction. These observations highlight how selection of patients for cardiac troponin testing varies across healthcare settings and markedly influences the positive predictive value for a diagnosis of myocardial infarction.-----------------------------------------------------------Comment by KEN GRAUER, MD (2/5/2019):-----------------------------------------------------------Excellent case by Dr. Smith — both for emphasizing important clinical concepts regarding optimal use of Troponin in the ED — and  — for a number of insightful subtleties on interpretation of serial tracings, with comparison to a prior tracing on the patient. I focus my comments on these ECG subtleties.For clarity — I have combined in Figure-1 the first 2 ECGs done in the ED, as well as the prior tracing done on this patient.Figure-1: The first 2 ECGs done in this case, together with a prior tracing done 4 years earlier (See text).==========================Clinical presentation of this case was especially challenging = an elderly, non-English speaking patient who initially denied any hint of chest pain. The prior ECG ( = TOP tracing in Figure-1) was not available at the time the patient was first seen — ...

Source: Dr. Smith's ECG Blog - February 5, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs