Learn to Love High Sensitivity Troponins | The EM & Acute Care Course
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- čas přidán 25. 02. 2021
- Learn to Love High Sensitivity Troponins by Jim Ducharme, MD
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KEY POINTS AND RECOMMENDATIONS
1. Even the most accurate troponin assay should not reassure you when the story and/or the ECG are high risk. Nothing has changed for those patients, even with an undetectable high-sensitivity troponin. Unstable angina is still a thing!
2. High sensitivity troponins are not negative or positive - they will be undetectable (below the limit of detection), measureable but below the 99th percentile (grey or “observe” zone), or measurable and above the 99th percentile (abnormal). The delta (or rate of rise) over 1-3 hours is important in interpreting detectable troponins. Rapidly rising (delta) troponins are indicative of myocardial injury even if below the 99th percentile threshold.
3. Higher troponin levels are associated with worsening prognosis, even if stable (not rising).
4. Consider non-ischemic cardiac and non-cardiac causes for presentation for all patients with detectable hs troponin.
5. Low-risk patients presenting after 3 hours with non-ischemic ECGs may be “ruled-out” with a single hs troponin result below the level of detection. These patients are at very low risk (less than 1%) of MACE (Major Adverse Cardiac Events).
6. Early presenters (less than 3 hours of symptoms) with undetectable troponin will require a delta troponin of between 1 and 3 hours before they can be confidently “ruled out.”
7. Patients with non-ischemic ECGs and detectable troponins below the 99th percentile at presentation will require a repeat sample. Patients with stable levels (unchanging) may not have acute myocardial ischemia, but they are at higher risk for both MACE and mortality than patients with undetectable troponins. These patients are in the “observe zone” - neither “rule-in” nor “rule-out.” There are no clear guidelines on the best management of these patients.
8. A combination of a clinical assessment and a second sample between 1 and 3 hours after the first is the recommended approach for serial sampling with hs troponin.
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great communicator and info
I went to the ER with mild chest pain but unusual shortness of breath while running. I'm a marathon runner, ran for 30 years so know my body well. My ECG came back borderline. My first HS Troponin I test was a 5. My 2nd test 2 hours later was a 6. They sent me home. I heard hard exercise can raise troponin as well
Super
Amal Mattus lecture on legal traps in ACS on this very channel states ACS exists even with two negative high sensitivity trops
I thought it was non-high sensitivity?
Is the absence of improvement in MI/PE outcomes adjusted for an unhealthier population? Older population? Thank you for the valuable information, it is going to shape our chest pain pathway at our sites.
high troponens - went up in hospital - normal ekg, nuclear stress test ok -- sent home after three days -- what should i do - i think i have them from exercise as i feel the same as when i went into hospital --- but it bothers me
*21:00** all of science improves if you remove the cash incentive.* most of these tests, if they assed 10cents, theyd still make millions. you cant have thousands of millions of dollars, EVER. thats the problem we all need to reckon w. -JC
I have high troponin levels .
9:30 ignore real symptomatic chest pain for our new fangled bio marker (...sounds like a...mistake) -JC
2 bad he can't articulate himself without foul language
Yes that caught me off guard as well. Made me chuckle. In his defense. Sometimes it just slips out when you're passionate about what you're conveying. Sometimes I choose to use foul language at the bedside to get my point across. Do not discount important information just because of use of foul language.