At Last A Better Heart Attack Screening Tool

Chest pain is one of the most common reasons people to go to the emergency department.  Many of these patients are experiencing chest pain having a cardiac origin.  Many are not.  Unfortunately, up to now there has been no good way to distinguish between the two and many patients who needed to be admitted and worked up or treated for their cardiac chest pain have been sent home by mistake.  This has led to many medical malpractice claims.  In fact, mistakenly discharging patients having a heart attack is perhaps the leading cause of medical malpractice claims arising out of visits to the emergency department.  I have handled a number of cases of this very nature, often involving tragic consequences to the patient who was mistakenly sent home.  On the other hand, it is too expensive and too burdensome to our system to admit everyone who has chest pain until a cardiac cause can be ruled out.  This brings us to the good news about assessing these patients.

Troponin is a protein which regulates muscle function.  Some types of troponin are associated only with the heart muscle.  When there has been damage to the heart, there is an increase in the level of these types of troponin in the blood.  Until recently, the available tests were not sensitive enough to detect small rises in troponin which might signal the beginning of a heart attack or other damage to the heart at a time when it could be successfully treated.  By the time the troponin levels increased enough to be detected, the damage to the heart was largely done.  An article in a recent issue of The Lancet, perhaps the finest of the British, peer-reviewed medical journals, discussed a new test which allowed detection at much lower levels.  Detection at these new levels allows for the identification of most of those people who are not having chest pain of a cardiac nature, who are at very low risk for a cardiac event in the near future, and who can be safely discharged.  The new testing protocol promises to save money and to save lives.  This is about as good a two for one as you can get.  I expect the new testing protocol to be widely adopted throughout the world in very short order.