troponin

[jok200]

at 12hours troponin i or t are 99-100% specific, if serial negative troponins are found overnight why would i stress test, even if high risk? also what is the significance of ....

For example, the 99th percentile value for the first-generation troponin T assay was 0.06 ug/L, which was reduced to <0.01 ug/L by the fourth-generation assay. I don't understand the 99th percentile part?


thnak-

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[jdh71]

sounds like homework

 

[jok200]

thanks

 

[VentdependenT]

You dont stress high probability patients, you cath them. You stress intermediate probability pts.

I dont understand the rest of your question. Im just a clinician.

 

[Scottish Chap]

at 12hours troponin i or t are 99-100% specific, if serial negative troponins are found overnight why would i stress test, even if high risk? also what is the significance of ....

For example, the 99th percentile value for the first-generation troponin T assay was 0.06 ug/L, which was reduced to <0.01 ug/L by the fourth-generation assay. I don't understand the 99th percentile part?


thnak-

99th percentile refers to the 99th percentile of a healthy population (i.e. healthy people should pretty much have no troponin detectable by immunoassay since, by definition, this signifies myocardial necrosis). One way reference ranges are determined is to pool serum from 100s of patients, and figure out what is probably 'normal', then set an acceptable coefficient of variation for the assay (acceptable error in assay precision). Typically, the troponin assays set the reference range with a 10% CV, but individual labs can set their own cut-offs. On a personal note, 'the 'troponin consult' is so painful for me. I can't wait until the highly sensitive (5--to-10 fold more sensitive troponin assay) used in some European centers becomes the norm in the U.S..

 

[Bostonredsox]

You dont stress high probability patients, you cath them. You stress intermediate probability pts.

I dont understand the rest of your question. Im just a clinician.

I cath them all. stress tests are boring, and they dont involve sticking a big needle and wire in a pt, which is frankly the only reason I am interested in them.

http://www.youtube.com/watch?v=xskFo75Wdhs

 

[surge55]

I cath them all. stress tests are boring, and they dont involve sticking a big needle and wire in a pt, which is frankly the only reason I am interested in them.

http://www.youtube.com/watch?v=xskFo75Wdhs

haha thanks so much for posting this. all of us at our program have watched this and have had some good story related to this.

 

[DrGen]

On a serious note, how about using echo to diagnose MI when troponin is +?

 

[Instatewaiter]

On a serious note, how about using echo to diagnose MI when troponin is +?

Yes.

We do this commonly. Newish patient with mildly positive trops and non diagnostic EKG we will look for a wall motion abnormality.

Now unless you can get a stat echo, do one reliably or have the luxury of time, it shouldn't change much

 

[My1021]

does the patient arise enough suspicious to buy him/her an angiogram?

 

[Instatewaiter]

does the patient arise enough suspicious to buy him/her an angiogram?

Yup. But the echo sometimes will help determine how quickly you need to get them to the lab.

CP that started 15 hours ago and the trop is 0.08 won't get too many panties in a bunch. 4 hours of chest pain a trop of 0.08 and a large, new anterior wall motion abnormality will. That next trop may be 40 and it just hasn't been enough time for the trop to rise.