Troponins replacing history taking?

The Resus Room

Simon Laing

Science, Emergencymedicine, Medicine, Health & Fitness, Em, Ae

4.8 • 678 Ratings

🗓️ 15 December 2016

⏱️ 16 minutes

🔗️ Recording | iTunes | RSS

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Summary

As the years tick by our healthcare systems work harder and harder to ensure that acute coronary syndromes are picked up as they present to our Emergency Departments, the evolution of high sensitivity troponins and their application have been key to this.

The utility of a test however is dependant upon it's application to the appropriate patient. In a heavily burdened system it can at times seem sensible to front load tests and 'add on a troponin' before we are even sure the history is consistent with a possible acute coronary syndrome. But is this a safe approach for our patients and what are the potential consequences?

In this podcast we run through a recent paper from the US on the topic. Whilst not the highest level of evidence and also looking at a system not entirely generalisable to the UK, it does highlight the aforementioned concerns and is a useful reminder to consider our approach to testing in patients with chest pain.

We are certainly not berating the use of troponin, we just think the paper serves a great reminder that testing must be appropriately applied.

Enjoy, and as ever we'd love to hear your feedback!

References

SIGN ACS Guidelines 2016

RCEMFOAMed SIGN ACS Guidelines

Causes of Elevated Cardiac Troponins in the Emergency Department and Their Associated Mortality. Meigher S. Acad Emerg Med. 2016

Cardiac Troponin: The basics from St. Emlyn’s

Rick Body via St Emlyns; One high sensitivity troponin test to rule out acute myocardial infarction

Transcript

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0:00.0	Welcome to the Recess Room podcast.
0:03.8	Five, four, three, two, one, fire.
0:12.2	Hit it?
0:13.3	Oh, yeah.
0:15.0	Oh, yeah.
0:17.8	So, hi, and welcome back to the Recess Room podcast. I'm Simon Lang. And I'm Rob Fenwick. And we are talking today, oh yes, about everybody's favourite topic. Traponins. Oh, Traponin. Traponin. Traponin. Traponin. Not only everyone's favorite topic, but probably everyone's favourite test as well.
0:38.9	So we're going to be talking about a paper that's recently come out that focuses on causes of raised troponins and troponin testing in the ED and what a raised troponin actually means, or more to the point, what causes it.
0:52.6	Because I think we're now getting more and more into
0:56.3	rapidly assessing patients and making sure that in such a pushed healthcare system that actually
1:02.3	we're trying to get blood test ordered before we fully assess patients and there is a real danger
1:09.1	in that and that's sort of what this paper actually nicely brings out.
1:14.1	That's good. It does need to be spoken about.
1:18.4	Okay, so there are loads of foam resources out there that focus on acute coronary syndrome.
1:23.8	And there's a really good one by the Archimphomed network, and we'll signpost that.
1:27.9	That's looking at the recent sign guidelines of that.
1:30.6	It's also at St Emlin's a load of podcasts on Troponium with Rick Body, the all-knowing
1:35.4	Rick Body on Troponin.
1:37.0	So again, make sure you're going to have look at that.
1:39.6	But before we start, let's just go with a bit of context.
1:43.3	Let's just talk about the definition of acute
1:45.6	coronary syndrome. And I'm going to read this. This is the sign guidelines. So acute coronary
1:51.8	syndrome is defined as encompassing a spectrum of unstable coronary artery disease.
	...

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