Computer says " normal, " troponin undetectable.

This was written by @BrooksWalsh, with one comment by SmithA middle-aged guy comes in with chest pain. No known cardiac disease, and he ’s healthy enough that he was hiking in some hilly terrain when he developed the symptoms..He comes into the ED, and they get an ECG which shows …… and is read by the computer as:Very reassuring, especially in the context of evidence that a computer interpretation of “normal” is “unlikely to have clinical significance that would change triage care. ” (HINT: this paper is very flawed, as Litell, Meyers and Smith point out in this article: Emergency physicians should be shown all triage ECGs, even those with a computer interpretation of " Normal "Also, the troponin (not high-sensitivity) isundetectable, so is this guy is ready for d/c, amirite?“Not so fast” you say?For starters, it would be reasonable to ask how soon after symptom onset the troponin was drawn - it was within 1-2 hours, a bit too soon to use a single marker. Also, perhaps serial ECGs would be preferred? Ah, we ’ll get to that later.But first, long-time readers of this blog are unlikely to fall for the “Computer said the ECG was normal” ploy. But you can’t call out the cath team based on reverse psychology, so let’s take a closer look at the ECG!Close up of ECGScrutinizing the ECG, we can see that there ’s some subtle ST segment elevation in leads III and aVF.The ST elevation is mild, though,< 1 mm in both leads. And of course this can h...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs