Which patients with chest pain actually need a troponin? Rick Body looks at how much we can trust the history, cardiovascular risk factors and our own clinical judgement before deciding to test.
Ep 299 – Which patients with chest pain need a troponin test? Read More
Could troponin tell us more than whether a patient has had an infarction? This 2017 reflection explores increasingly sensitive assays, cardiovascular risk and personalised baseline measurements, while distinguishing exciting possibilities from clinical benefits that still needed to be demonstrated.
Troponin: more than a marker of infarction? Read More
A patient’s chest pain has resolved and the emergency department ECG looks relatively reassuring. This teaching case asks what information might still be missing, using the contrast with an earlier ambulance tracing to explore dynamic ECG changes and the importance of clinical detective work.
Cardiology Case 05: Detective work Read More
How can emergency departments reduce delays for patients who need transfer for primary PCI? This 2015 account of Manchester’s DIDO-30 project examines early ECG recording, recognition and escalation, with practical ideas for improving pathways through staff feedback, shared responsibility and rehearsing the whole process.
Good times part 1: DIDO-30 for STEMI Read More
Could an automated blood test make the original MACS chest pain rule practical to use? This 2015 research update explains validation with a new heart-type fatty acid binding protein assay, how the rule was recalibrated and why testing its effects in clinical practice was the next step.
The MACS rule: a new user-friendly version Read More
Does more severe chest pain make a heart attack more likely? Rick Body describes a 2014 study of emergency department patients, showing the difference between a statistically significant association and a useful diagnostic test, and why mild discomfort alone cannot provide reassurance about the underlying cause.
Is severe chest pain more likely to be a heart attack? Read More
Rick Body discusses a 2014 study of emergency physicians’ judgement in suspected acute coronary syndromes. He explores the limitations of clinical judgement alone, the potential contribution of ECG and troponin results, and why promising findings still required validation before being used as a discharge strategy.
How accurate is clinical judgement for acute coronary syndromes? Read More
Rick Body introduces the original Manchester Acute Coronary Syndromes decision rule in this 2014 research report. He explains its derivation and external validation, how clinical features and biomarkers contribute to risk assessment, and the questions that still needed answering before routine use.
The MACS Rule: Immediate ‘rule in’ and ‘rule out’ for suspected cardiac chest pain Read More
