Do you remember when it took three days to 'rule in' or 'rule out' an acute myocardial infarction (AMI)? When I was a medical student doing my first clinical attachments, I remember doing ward rounds on the CCU seeing patients with suspected AMI. The way they were managed is a million miles from what we do now. Back then, patients would have serial ECGs and then be admitted for cardiac enzyme evaluation over the course of the next 3 days. We'd measure CK, AST and LDH. 'CK' was the so-called 'early marker', which would rise early after the start of an AMI. Today we use CK as a marker of skeletal muscle damage (e.g. rhabdomyolysis). AST and LDH (today we think of these as liver function tests, I know) were the 'late markers' - and by late I really mean late - we might see a rise on days 2 and 3.
Could you imagine for a second, in today's world, ruling out AMI because their CK and LFTs were normal? It's completely unthinkable. That's how much cardiac troponin has changed our practice. We rely on it so completely to diagnose AMI. And yet, it's one of the most misunderstood tests in medicine. Given how much we use it, I guess we feel that we all should know lots about this test. But doctors still have so many questions. Here are just a few:
This is just a brief list. With the research I do in this area and my experience developing protocols/guidelines, people get in touch to ask questions like this quite a lot. There are loads of questions that people ask - but there are lots of themes in common. We thought it was about time we produced a handy run down in the true spirit of #FOAMed.
Take a listen to Part 1 of our troponin podcast. While Simon and Iain have been prolifically churning out spectacular stuff for some time now, this is my debut on the St. Emlyn's podcast. I really enjoyed talking about troponin with Iain - and I hope we covered some useful stuff.
We'll cover more in part 2, when we'll move on to discussing high sensitivity troponins, what they are, how to use them and how to speak the troponin lingo. Please get in touch if there's anything we haven't covered that you'd like us to, or if there's anything you'd like us to elaborate on some more!
Rick
Ep 231 - February and March 2024 Monthly Round Up - Liver disease, mCPR, Global Health and Elderly patients
Ep 230 - Top Twenty Papers of 2023 - Part 2 - Haemorrhage and Cardiac
Ep 229 - Top Twenty Papers of 2023 - Part 1 - Airway
Ep 228 - January 2024 Monthly Round Up - New Year Resolutions, intubating poisoned patients and wellbeing in the ED
Ep 227 - December 2023 Round Up -Major bleeding decison making, E-scooters, AI and advanced resuscitation possibilities
Ep 226 - October and November 2023 Monthly Round Up - Trauma, Resuscitation, Aortic Dissection and Silence
Ep 225 - A deep dive into ECMO with Andy Curry
Ep 224 - September 2023 Monthly Round Up - Top Ten Papers and more
Ep 223 - July and August 2023 Monthly Round Up
Ep 222 - Monthly Round Up June 2023 - Airways, AMAX4, Head Injuries, TXA and more
Ep 221 - Brief Resolved Unexplained Events with Jilly Boden at the PREMIER Conference
Ep 220 - Penetrating Injuries with John O’Neil at the PREMIER Conference
Ep 219 - Blast Injuries with Chris Hillman at the PREMIER Conference
Ep 218 - Non epileptiform seziures with Steve Warriner at the PREMIER Conference
Ep 217 - Weaning the wheezy child with David James at the PREMIER Conference
Ep 216 - April 2023 Monthly Round Up: HALO procedures and Blood Transfusion
Ep 215 - March 2023 Monthly Round Up
Ep 214 - Shock from St Emlyn’s Medical School
Ep 213 - Sensitivity and Specificity (CAN 10)
Ep 212 - February 2023 Monthly Round Up
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