Triage^® Cardiac Panel: Rapid Rule-In of Acute Myocardial Infarction

Chief Complaint:
Chest pain and shortness of breath

Present Illness:
A 59-year-old man enters the emergency department with chest pain. Onset of chest pain occurred three to four hours ago. Patient self-medicated with TUMS and aspirin without relief. Patient is short of breath with chest pain severity of 7/8/10 (scale 1-10). Patient is not experiencing nausea or vomiting.

Past Medical History:

• Family history of MI
• Patient has hypertension, hyperlipidemia, and obesity
• Received elective percutaneous transluminal coronary recanalization five years earlier
• No previous MI

Emergency Department Assessment:

• Physical Exam
• Temperature: 97.5
• Blood Pressure: 195/190
• Pulse: 75
• Weight: 245
• Height: 5’9”
• General: Frightened, alert, oriented to person/place/time
• Cardiovascular: Regular rate rhythm and normal heart sounds
• Medications given in the emergency department: Nitroglycerin, aspirin, IV heparin, and oxygen

ECG

• Nondiagnostic ECG

CARDIAC MARKER TESTING Traditional Algorithm vs Accelerated Protocol
TIME	CK-MB (10 ng/mL cutoff*)		Myoglobin (170 ng/mL cutoff*)		Troponin I (0.6 ng/mL cutoff*)		Initial Diagnosis and Triaging Decisions
	Traditional Algorithm	Accelerated Protocol	Traditional Algorithm	Accelerated Protocol	Traditional Algorithm	Accelerated Protocol	Traditional Algorithm	Accelerated Protocol
Baseline	5.9		-		<0.2		Patient remained in ED under observation for first 6 hours after presentation
45 Minutes	-		-		-
90 Minutes	-		-		-		MI diagnosed at 6 hours
6 Hours	18.0		-		2.5
12 Hours	20.5		-		8.5		Patient sent to CCU at 6 hours

* Cutoffs are reflective of reference ranges determined by hospital.

Click here to see how the accelerated protocol could have impact the triaging & disposition of this patient