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
A 2014 introduction to cardiac troponin, built around common questions from the emergency department. The post introduces Rick Body and Iain Beardsell’s podcast on interpreting results, including causes of elevation, timing, changes between samples and the complications posed by renal failure.
Cardiac Troponin: The basics from St. Emlyn’s Read More
A patient with ongoing chest pain has an ECG that does not fit a familiar STEMI pattern. This educational case from 2014 asks how the clinical history and shape of the ST segments should influence the next decision, before revealing the angiographic findings and outcome.
Cardiology Case 04: An unusual ECG 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
An illustrative chest-pain case challenges readers to interpret two ECGs alongside an early troponin result. This 2014 teaching post explores subtle high lateral STEMI, reciprocal changes and the risk of letting an initially unremarkable blood test distract from concerning ECG findings.
Cardiology Case 03: Are you missing the STEMI? St. Emlyn’s Read More
Does giving prasugrel before angiography help patients with non-ST-elevation acute coronary syndromes? This 2014 appraisal of ACCOAST examines the balance between ischaemic outcomes and major bleeding, alongside patient selection, the composite endpoint and the limits of applying the findings more widely.
JC. ACS: Antiplatelets ACCOAST-ed? Read More
A 2013 journal club reviews Louise Cullen and colleagues’ validation of a two-hour strategy using high-sensitivity troponin to assess chest pain. It explores diagnostic performance, the proportion potentially suitable for early discharge and how patient selection and subsequent interventions complicate interpretation.
JC: Cullen on high sensitivity Troponin. St.Emlyn’s Read More
How seriously should we take ST depression when the patient is now pain-free? This hypothetical cardiology case explores dynamic ECG changes, serial troponin results and clinical context, then reviews the 2012 evidence on when patients with NSTEMI should undergo coronary intervention.
Cardiology Case 02: ST depression, no rush? St.Emlyn’s Read More
