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Related Concept Videos

Blood Studies for Cardiovascular System I: Cardiac Biomarkers01:20

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Cardiac biomarkers are enzymes, proteins, and hormones released into the blood when cardiac cells are injured. They are powerful tools for triaging.
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
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Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
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Acute Coronary Syndrome III: Diagnostic Studies01:30

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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Acute Coronary Syndrome I: Introduction01:30

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Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
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Acute Coronary Syndrome IV: Interprofessional Care01:28

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IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
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Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT01:25

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Calcium-Scoring CT ScanA calcium-scoring CT scan, also known as coronary artery calcium (CAC) scan, detects calcium deposits in the coronary arteries. This test assesses the risk of coronary artery disease (CAD), which can lead to cardiovascular events such as angina, heart failure, and sudden cardiac arrest.A calcium-scoring CT scan is generally recommended for individuals at intermediate risk of CAD without symptoms. It includes:Men aged 40-75 and women aged 50-75: Especially those with a...
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Angina, a symptom of myocardial ischemia, requires a structured nursing management approach to ensure effective care and prevent complications like myocardial infarction. Comprehensive nursing care involves assessing, diagnosing, planning, implementing interventions, and evaluating outcomes, all tailored to the individual patient's needs.Patient AssessmentNursing assessment begins with a detailed subjective evaluation of symptoms, which typically include chest pain or pressure radiating to the...
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Performance of High-Sensitivity Troponin T Risk Stratification Strategies for 90-day Cardiac Death or Myocardial

R Gentry Wilkerson1, Nicklaus P Ashburn2, Anna C Snavely2,3

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Critical Pathways in Cardiology
|July 16, 2025
PubMed
Summary

The high-sensitivity troponin T (hs-cTnT) one-and-done and ESC 0/1-hour strategies show modest 90-day performance for cardiac death or MI. Adding the HEART score improves safety but reduces efficacy.

Keywords:
chest painmyocardial infarctionrisk stratificationtroponin

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Biomarker Research

Background:

  • Established 30-day performance of European Society of Cardiology (ESC) 0/1-hour and "one-and-done" high-sensitivity troponin T (hs-cTnT) strategies.
  • Limited understanding of the 90-day performance of these hs-cTnT strategies in a US population.
  • Need to evaluate long-term outcomes beyond initial emergency department assessment.

Purpose of the Study:

  • To assess the 90-day performance of ESC 0/1-hour and "one-and-done" hs-cTnT strategies.
  • To evaluate the impact of incorporating the HEART score on these strategies.
  • To determine the negative predictive value (NPV) and efficacy for identifying 90-day cardiac events.

Main Methods:

  • Prospective, multisite US cohort study of adults presenting with chest pain.
  • Utilized 0- and 1-hour hs-cTnT measurements for ESC 0/1-h algorithm classification.
  • Defined "one-and-done" strategy by hs-cTnT below the limit of quantification at 0-h.
  • Primary outcome: adjudicated 90-day cardiac death or myocardial infarction (MI).
  • Calculated NPV and efficacy, with and without the HEART score.

Main Results:

  • In 1462 patients, 14.0% experienced 90-day cardiac death or MI.
  • The "one-and-done" strategy had 32.8% efficacy and 99.0% NPV.
  • The ESC 0/1-h algorithm showed 57.8% efficacy and 98.3% NPV.
  • Adding the HEART score decreased efficacy for both strategies but increased NPV.
  • Combined HEART score and "one-and-done": 20.1% efficacy, 99.7% NPV.
  • Combined HEART score and ESC 0/1-h: 30.8% efficacy, 99.3% NPV.

Conclusions:

  • Both "one-and-done" and ESC 0/1-hour hs-cTnT strategies demonstrated modest 90-day performance.
  • The strategies had a low rate of missed 90-day cardiac death or MI.
  • Integrating the HEART score enhanced safety (higher NPV) at the cost of reduced efficacy (fewer patients ruled out).