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)


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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Dr Alexandra CM Thompson

Senior Trust Cardiology Research Fellow, Darlington Memorial Hospital

Dr Ashfaq Mohammed

ST3 Cardiology Trainee, Darlington Memorial Hospital

Prof. Jerry Murphy

Hon. Prof. of Cardiovascular Medicine
Consultant Cardiologist, Darlington Memorial Hospital


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