Conclusion to 43 Year Old Female – Chest Discomfort After Eating

Conclusion Going back to our initial case; the patient first stopped in the emergency department where she had some labs drawn and a chest X-ray performed. Her initial troponin-I on a current-generation assay (in the U.S.; not high-sensitivity) came back undetectable at < 0.01 ng/mL (ref <= 0.04 ng/mL). Thankfully an astute emergency physician recognized the significance of the patient’s ECG and activated the cath lab before that value returned. Had they waited for the troponin they would have been falsely re-assured as it was still very early in the patient’s MI and the level simply had not had time to appreciably rise. I doubt this patient would have gone to cath if they knew her initial troponin was “negative.” Cath revealed an acute lesion in the proximal LAD that was stented to good result.   Addendum: Dr. Smith’s Formula Earlier in this post I mentioned Dr. Smith’s formula for differentiating anterior STEMI from early repolarization. I love the formula and have found it to be highly accurate but there’s a reason I didn’t use it here: We aren’t allowed to! You cannot apply the formula to ECG’s with possible reciprocal ST-depression (along with several other exclusions). While it is tempting to use the formula because the abnormalities here are not impressive, the presence of any reciprocal changes precludes its use. Had we tried to use it (with values of 2.0 mm, 375 ms, 13.5 mm), it would have given u...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: Cases Vince DiGiulio Source Type: research