Diagnosing Acute Coronary Syndromes: The Troponin Conundrum

As the sensitivity of Tn assays rises, electrocardiographic and clinical evidence of ACS become more — not less — important in treatment decisions.

The diagnostic criteria for myocardial infarction (MI) are obtained from the triad of clinical presentation, electrocardiogram (ECG) changes, and serial cardiac enzyme or biomarker measurements. In recent years, the emphasis on biomarkers — specifically, troponin (Tn) — has increased, while ECG findings and clinical symptoms have received relatively little attention. Nonetheless, a detectable Tn level alone does not equal a diagnosis of MI.

TROPONIN AND MYOCARDIAL DAMAGE

Acute coronary syndromes (ACS) is a general term used when clinical symptoms and signs of myocardial ischemia are caused by obstruction of flow through the coronary arteries, and it typically has included both MI and unstable angina. A European Society of Cardiology and Ameri…

Authors

J. Stephen Bohan, MD, MS, FACP, FACEP

Disclosures

RoyaltiesKlint Law Firm

Editorial boardsCritical Decisions in Emergency Medicine

J. Stephen Bohan, MD, MS, FACP, FACEP

Disclosures

RoyaltiesKlint Law Firm

Editorial boardsCritical Decisions in Emergency Medicine

Joel M. Gore, MD

Disclosures

Grant/Research SupportNIH–National Heart, Lung, and Blood Institute

Joel M. Gore, MD

Disclosures

Grant/Research SupportNIH–National Heart, Lung, and Blood Institute