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ECG education

Is this an acute coronary syndrome?

Vivienne Miller

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Abstract

A normal or unchanged ECG does not exclude an acute coronary syndrome.

Key Points

  • Cardiac symptoms may be atypical so it is wise to always remember this.
  • A normal or unchanged ECG does not exclude an acute cardiac syndrome.
  • An acute coronary syndrome requires a serum troponin test for diagnosis if the patient has a left bundle branch block.
  • If you think it is possible that the patient could have an acute coronary syndrome, do not waste time doing an urgent serum troponin test. The patient needs referral to a hospital centre that can do angiography.
  • It follows that performing a serum troponin test in general practice is useful only to reassure the doctor and patient that the presentation was definitely not an acute coronary syndrome.
  • If you request an urgent serum troponin test, ensure you are contactable for notification of the result and to take appropriate action.

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