Let’s just check a troponin…

TropMakam

A 73 year old male with DM2, HLD, HTN, CKD stage 3, and PVD presents with crushing, substernal chest pain of 2 hours duration and dynamic ST changes on a series of EKGs. Well, you better check that troponin and get in touch with cardiology! But what about that 45 year old male with atypical chest pain and no risk-factors. Just go ahead and check with cardiac biomarkers? According to a new study in JAMA by our own Drs. Makam and Nguyen, the measurement of cardiac biomarkers in the emergency room may be excessive. Despite a broad definition of coronary symptoms (chest pain, nausea, vomiting, heartburn, upper abdominal pain, palpitations, shortness of breath or other breathing problems, general malaise, fainting or dizziness, sweating, fluid abnormality, edema, jaw pain, neck pain, or arm pain), they found that nearly 30% of all patients in the ER that were tested with cardiac biomarkers actually exhibited no symptoms of a heart attack. This practice, however, seems to extend to the inpatient side: among those who were hospitalized, ~35% were tested for cardiac markers despite showing no symptoms of a heart attack. Furthermore, their data suggests that between 2009-2011, this testing lead to 1.7 million false-positive results. For more information, check out the entire article here.

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