Maleficent Troponins

We physicians are obsessed with classifying, sorting, and differentiating in a quest for never-ending precision. We gather all manner of “facts” from our patients. Sights, smells, reactions to pushing or pulling. We divine sounds with antiquated stethoscopes or peer underneath the skin with ultrasound. We subject them to tests of blood, urine, and fluids from any place our needles can reach.     All of this is to arrive at an exact diagnosis that is often frustrated by the secondary nature of the data. Our disappointment has driven us mad, but the promise of exactness from biomarkers leaves us giddy. We have convinced ourselves that these laboratory tests will provide us the dichotomous yes/no answers we tell ourselves that our patients demand, but is really more for us. Answers without all of the messiness.   Does the patient have pneumonia? Check procalcitonin. Want to know if he has a pulmonary embolism? How high is the D-dimer? Why is the patient short of breath? Better get a BNP level. Chest pain? Run a troponin level (three times every four hours).   Troponins have turned on us, however, and emergency physicians and cardiologists are quickly learning to hate their old friend. Troponin levels were such a good biomarker. Positive levels were a clear marker of acute myocardial infarction; negative values ruled out the diagnosis. Exactly what we wanted from a biomarker. As the clinical chemists devised ways to measure troponins at lower and lower levels, however, we...
Source: Spontaneous Circulation - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs