Emergency Cases Northwest Group

001 Phoney Tropony

Situation

Man presented with STEMI, but at 2 hours his first troponin was only 8.

Background

A 59 year old man presented with 2 hours of chest pain/left arm pain. His ECG showed a STEMI. Ambulance called for PPCI. But it took so long to arrive that not only was his first troponin reported as 8 (taken too early at 2 hours post pain onset) but I actually managed to do a 4 hour post pain onset troponin which was later reported as >800.

Assessment

Guidelines say Trop0 should be taken 3 hours from the onset of pain. If you do it earlier than that a) it might be raised, which may be helpful OR b) it might be normal and the patient may still be having an MI thus falsely reassuring you. Or it may really be normal.

Recommendation

Follow the guidelines and do a Trop0 3 hours after the onset of pain

If triage have done the Troponin before you and taken it too early then do it again, on time.



PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Date 09/02/2023

Source SN1

Review YES

Review YES

Emergency Cases Northwest Group