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