Clinical Case Database / Category: Case Based Discussion

Not all chest pain is cardiac, even when the troponin is high

Publication details

Dr Alexandra CM Thompson, Dr Ashfaq Mohammed, Prof. Jerry Murphy
Foundation Years Journal, volume 8, issue 2, p.42 (123Doc Education, London, February 2014)

Abstract

A 64 year old man presents with central chest heaviness, dyspnoea with a positive troponin and is diagnosed with a myocardial infarction. This scenario is encountered frequently on the acute medical take but differentiating acute coronary syndromes from other causes of chest pain is not always straight forward. This article provides an overview of the case and investigations and reviews the reasons for troponin elevation and the pitfalls of assuming that this always represents myocardial infarction.

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Authors

Dr Alexandra CM Thompson

Senior Trust Cardiology Research Fellow, Darlington Memorial Hospital
acmthompson@doctors.org.uk

Dr Ashfaq Mohammed

ST3 Cardiology Trainee, Darlington Memorial Hospital
ashfaq.mohammed@cddft.nhs.uk

Prof. Jerry Murphy

Hon. Prof. of Cardiovascular Medicine
Consultant Cardiologist, Darlington Memorial Hospital
jerry.murphy@cddft.nhs.uk

References

1. National Institute for Health and Clinical Excellence (NICE) clinical guideline 95. Chest pain of recent onset: Assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin, 2010. http://guidance.nice.org.uk/CG95/NICEGuidance/pdf/English
2. Thygesen K, Alpert JS, White HD, as part of the Joint ESC/ACCF/AHA/WHF Task Force for the
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14. Assomull RG, Lyne JC, Keenen N, et al. The role of cardiovascular magnetic resonance in patients presenting with chest pain, raised troponin, and unobstructed arteries. Eur Heart J 2007,28:1242-49.
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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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