High-sensitivity troponin assays in the evaluation of patients with acute chest pain in the emergency department.
Summary of "High-sensitivity troponin assays in the evaluation of patients with acute chest pain in the emergency department."
Abstract Evaluating patients with acute chest pain presenting to the emergency department remains an ongoing challenge. The spectrum of etiologies in acute chest pain ranges from minor disease entities to life-threatening diseases, such as pulmonary embolism, acute aortic dissection or acute myocardial infarction (MI). The diagnosis of acute MI is usually made integrating the triad of patient history and clinical presentation, readings of 12-lead ECG and measurement of cardiac troponins (cTn). Introduction of high-sensitivity cTn assays substantially increases sensitivity to identify patients with acute MI even at the time of presentation to the emergency department at the cost of specificity. However, the proportion of patients presenting with cTn positive, non-vascular cardiac chest pain triples with the implementation of new sensitive cTn assays increasing the difficulty for the emergency physician to identify those patients who are at need for invasive diagnostics. The main objectives of this mini-review are 1) to discuss elements of disposition decision made by the emergency physician for the evaluation of chest pain patients, 2) to summarize recent advances in assay technology and relate these findings into the clinical context, and 3) to discuss possible consequences for the clinical work and suggest an algorithm for the clinical evaluation of chest pain patients in the emergency department.
Affiliation
Department of Emergency and Critical Care Medicine, City Hospital Nuremberg, Nuremberg, Germany.
Journal Details
This article was published in the following journal.
Name: Clinical chemistry and laboratory medicine : CCLM / FESCC
ISSN: 1434-6621
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21892907
- DOI: http://dx.doi.org/10.1515/CCLM.2011.695
Medical and Biotech [MESH] Definitions
Troponin
One of the minor protein components of skeletal muscle. Its function is to serve as the calcium-binding component in the troponin-tropomyosin B-actin-myosin complex by conferring calcium sensitivity to the cross-linked actin and myosin filaments.
Troponin T
One of the three polypeptide chains that make up the TROPONIN complex. It is a cardiac-specific protein that binds to TROPOMYOSIN. It is released from damaged or injured heart muscle cells (MYOCYTES, CARDIAC). Defects in the gene encoding troponin T result in FAMILIAL HYPERTROPHIC CARDIOMYOPATHY.
High-throughput Screening Assays
Rapid methods of measuring the effects of an agent in a biological or chemical assay. The assay usually involves some form of automation or a way to conduct multiple assays at the same time using sample arrays.
Chromatography, High Pressure Liquid
Liquid chromatographic techniques which feature high inlet pressures, high sensitivity, and high speed.
Troponin I
One of the three polypeptide chains that make up the TROPONIN complex. It inhibits F-actin-myosin interactions.
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