ఎమర్జెన్సీ మెడిసిన్: ఓపెన్ యాక్సెస్
అందరికి ప్రవేశం

నైరూప్య

అక్యూట్ కరోనరీ సిండ్రోమ్ నిర్ధారణ: జనరల్ ప్రాక్టీషనర్లు మరియు కార్డియాలజిస్టులకు ఒక సవాలు

రాబర్ట్ TA విల్లెమ్‌సెన్, బాస్ LJH కీట్‌సేలేర్, రాన్ కుస్టర్స్, ఫ్రాంక్ బంటిన్క్స్, జాన్ FC గ్లాట్జ్ మరియు గీర్ట్ జాన్ దినంట్

Three patients present with chest pain to their general practitioner. In all three cases, the patient is suspected of acute coronary syndrome (ACS). In the first case, a coronary artery disease causing the complaints is ruled out since troponin levels remain within the normal range. In the second case, troponin is elevated due to non STelevated myocardial infarction. In the third case, troponin is elevated due to cardiac cell damage in severe pneumonia (i.e. cardiac damage is not caused by a coronary artery occlusion). In cardiology, diagnostic tools for ruling ACS in or out are becoming increasingly sensitive. In general practice, diagnostic means to discriminate between ACS and less severe causes of chest complaints remain poor. Both situations challenge physicians working in their respective fields. Cardiologists must deal with a decrease in testing specificity due to the increasing analytical sensitivity of high-sensitivity troponin, and face the dilemma of whether or not to perform invasive coronary angiography in cases of doubt instead of while general practitioners are still lacking adequate diagnostic tools. These difficulties are illustrated in three cases where patients’ present chest complaints in primary care and are eventually referred to a cardiologist. Notwithstanding the presence of the aforementioned dilemmas, combining clinical reasoning with current definitions of ACS and myocardial infarction leads to an unambiguous diagnosis in all three cases.