Cardiac arrest with anterior-inferior STEMI: Guess the value of the initial ED high sensitivity Abbott troponin I

A ~40 year old woman started having chest discomfort.  She called 911 after an uncertain amount of time.  EMS arrived and recorded thisprehospital ECG:Obvious Anterior and Inferior STEMI, consistent with LAD occlusionAfter recording this ECG, the patient went intoventricular fibrillation.She was rapidly defibrillated.The cath lab was activated by the paramedics.She arrived complaining of chest pain, with a BP of 110/70.An ED ECG was recorded:It looks worse stillAside: Should the patient receive antidysrhythmics to prevent recurrent VT/VF?  See discussion below on both beta blockers and other anti-dysrhythmics.The patient went to the cath lab.22 minutes after leaving for the cath lab, the initial High Sensitivity Troponin I returned (Abbott Architect, Limit of detection by FDA guidelines at 4 ng/L, 99% Upper Reference Limit for Women = 16 ng/L).  It had been drawn at arrival.Result: Below 4 ng/L (below the level of detection)Angiogram/Intervention100% Distal LAD occlusion due to coronary dissection was found and opened and stented.Repeat ECG next day:The 2nd troponin, drawn 3 hours, 25 minutes after arrival, returned at 803 ng/L.Here is the troponin profile over 7 blood draws (more than is necessary!).  You can see that the highest value (which may or may not be the peak) was over 16,000 ng/L.  16,665 ng/L roughly correlates with a level of 16.665 ng/mL on the older, contemporary (4th generation) Abbott troponin I assay.  It is typi...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs