Let's move on to cardiac markers. Dr. Latovsky, before we talk about troponins, I'd like to discuss a bit about

KMB. It seems to me that KMB has become sort of an ancient relic, a thing of the past.

In what situations would a KMB be useful in 2011?

Well, we still run CKs along with our triponins. We often get the CK result actually earlier before our triponants, so it often tells us right away that, you know, the patient's chest being really is a schemic. We can start anti-plately and antithrombotic earlier because our CK comes back about 15 minutes earlier than our antipotin for some reason.

The other time that a CK may be of value is because of the long half-life of a triponin and may not clear for 7 to 10 days. If someone gets discharged from the hospital within three days of acute infarction or four days in acute infarction, they come back with pain, then the CK, which will have cleared earlier if it's a rise you can sometimes diagnose re-infarction or re-aschemia with an elevation of the ck so that'd probably be the you know the two reasons why

cKs are still a valuable biochemical marker in my opinion dr otofsky do you always do

two sets of troponins on your patients you suspect of ACS,

who haven't immediately left your department because of a stemmy?

For example, let's say our elderly patient with this presumed new left bundle branch block

is not taken to the cath lab, is not given thrombolysis,

and her pain started 15 hours ago instead of four hours ago.

Presumely, since the peak sensitivity of troponin for MI is about 10 to 12 hours, you'd only need to

do one set of troponins. Do you ever only do one set of troponins? What's your take on that?

I do, but it's not common. Remember, the majority of patients who present with a

Kipmacharninfar infarction present within about three hours of the illness of the chest pain.

So the overwhelming number of patients who present with chest pain have a recent onset of chest pain.

And that patient population would be wrong to assume that a single

tripon excludes my carnal fraction. So that's, so the majority of our patients, if they present

with, you know, a chest pain for an hour, two, or three, and their pain has disappeared,

those are the kind of patients you really need to hold for a second state of cardiac markers eight, nine, ten hours after the onset of their chest pain. Do I ever rely on a single set of cardiac markers in the answer? I do. It's not common, but I do. If the pain was yesterday and they come in today, because they want it to be checked out, and the opponent is completely negative, that will will reassure me and I won't do a set of cardiac markers on those patients

if the pain was yesterday the day before.

I don't think there's any value in holding them two hours or four hours later for a second

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