emDocs - July 30, 2016 - Authors: Kapoor S and Zeserson E
Edited by: Santistevan J, Long B and Koyfman A
"PEARLS AND PITFALLS
- A completely normal ECG does not exclude ACS and occurs in 1-6% of patients.
- Repeat ECGs can be helpful in making the diagnosis of NSTE-ACS and should be used liberally.
- Troponin levels should be repeated at least 3-6 hours after symptom onset.
- Relief of chest pain with nitroglycerin cannot rule in or out NSTE-ACS.
- After diagnosis of NSTE-ACS risk-stratification is helpful to guide further management.
- Consider ECG changes and troponin levels along with initial presentation when risk-stratifying patients.
- Atypical symptoms such as weakness and nausea should not exclude NSTE-ACS from differential diagnosis, especially in the elderly, diabetics and women.
- Available data suggests that patients with troponin elevations at time of diagnosis of NSTE-ACS will benefit from early-invasive treatment."
