Updating an institutional chest pain algorithm taylor handley dating
It is important to highlight five aspects when applying troponin-based strategies in clinical practice (): First, they should be used only in conjunction with full clinical assessment, including a pre-test probability assessment to identify those patients at high risk who may not be suitable for early discharge.Second, these strategies should be considered triage strategies rather than definite diagnostic strategies, as additional imaging tests e.g.
There are some rare circumstances when high or even very high c Tn concentrations are observed in the absence of myocardial injury, for example due to analytical assay interferences.
heart failure or other structural cardiac disorders as signs of MI.
In the absence of overt myocardial ischaemia, elevated c Tn levels are often labelled as ‘false-positive’ hs-c Tn results.
In case of a c Tn mismatch, contact the laboratory for ruling-out analytical interferences resulting in real but very rare ‘false-positive’ c Tn measurements (e.g.
troponin auto-antibodies affecting c Tn I or skeletal muscle disease affecting c Tn T The most important clinical advantage of the new, more-sensitive c Tn assays is their ability to substantially reduce the ‘troponin-blind’ interval in the first hours of an MI and thereby do allow for novel strategies to early rule-out or rule-in of NSTEMI.