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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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domingo, 31 de julio de 2016

Troponin for Atypical Symptoms

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PART I – THE POWER AND PITFALLS OF TROPONIN
SinaiEM - By Jean Sun - July 25, 2016
..."So what about obtaining a single troponin if patients report symptoms well beyond the 6 hour window? Unfortunately, there are no good studies or trials to support the prognostic value of a single troponin measurement. Because of this, a single cTnI measurement is not recommended by the ACC/AHA or any other clinical guidelines, and the clinical practice of doing so is not evidence-based."
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PART II – THE SIGNIFICANCE OF ANGINAL EQUIVALENTS
SinaiEm - By Jean Sun - July 26, 2016
..."So far, it seems that serial troponins are the way to go, even if our elderly patients don’t present with typical chest pain symptoms. In fact, we may want to be even more vigilant when it comes to anginal equivalents. Is there any evidence to the contrary, or any basis for the single troponin in atypical chest pain?"
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SinaiEM - By Jean Sun - July 29, 2016
..."In general, the literature suggests that elderly patients who present with atypical chest pain should receive at least two troponins for several reasons: 1) though there are many practical reasons to order a single troponin measurement in the ED, the practice of doing so for patients at risk for ACS is not yet supported by rigorous evidence; and 2) elderly patients with atypical presentations (particularly painless shortness of breath) are at risk of worse outcomes and under-treatment compared to patients with classic ischemic chest pain. This being said, there are studies to support the utility of serial troponins at shorter intervals (3-4 hours in particular, but even a 1-hour interval can be justified if a clear time of onset is established). A compromise might be to continue to order serial troponins, but recognize that you don’t always need to adhere to the 6 hour guideline."