In-Reply-To: <[log in to unmask]
k>
> Is anyone aware of any hospital in the UK performing rapid triage and
> investigation of cardiac sounding chest pain using troponin I and
> exercise testing? Or seen it in action in the States? I wonder
> particularly whether it leads to an increase in reattendance rates.
We looked into this. Troponin I is cardio-specific but has the problems
that all the enzymes do; none is released until cell autolysis starts,
which is 4 hours after the onset of ischaemia. This is too long to wait
for thrombolysis/hot angioplasty. However, acute exercise testing does
sound promising, but does cost a lot to set up and run.
I have audited our returns with chest pain; we set as our criterion a 2%
reattendance/death rate with myocardial infarction within 30 days of
discharge from A&E with a diagnosis of chest pain with MI excluded by
conventional means. Our return rate was actually 0.5%.
This compares with the published rate from one of these exercise labs of
4%.
Best wishes,
Rowley Cottingham
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Look, it's easy. Does your proposal help my patient? If it does, then I
shall embrace it with all my heart. If it does not, go away and find
another proposal.
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