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This case is over & done with, so I'm not seeking medical advice - I'd just like some perspective from any Cards fellows/attendings.
38 yo diabetic male with hypercholesterolemia and a father who had CAD, but not until his 50's presents to the ED with a good chest pain story and gets a dobutamine stress echo after initially negative trops and ECG. During the stress he develops squeezing chest pain (described with a clenched fist) associated with nausea which resolves after about 20 minutes. The stress test was negative for wall motion abnormality or ST changes, but somehow a troponin gets sent after the stress test and it comes back 30 times the 99th percentile value for our assay. It is resent 2 hours later in hopes that the initial value was a "lab error" and it comes back 30% higher.
What would you do with this patient?
38 yo diabetic male with hypercholesterolemia and a father who had CAD, but not until his 50's presents to the ED with a good chest pain story and gets a dobutamine stress echo after initially negative trops and ECG. During the stress he develops squeezing chest pain (described with a clenched fist) associated with nausea which resolves after about 20 minutes. The stress test was negative for wall motion abnormality or ST changes, but somehow a troponin gets sent after the stress test and it comes back 30 times the 99th percentile value for our assay. It is resent 2 hours later in hopes that the initial value was a "lab error" and it comes back 30% higher.
What would you do with this patient?