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Related Concept Videos

Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

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...
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

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...
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

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...
Myocarditis II: Clinical Features and Diagnostic Tests01:27

Myocarditis II: Clinical Features and Diagnostic Tests

Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
Blood Studies for Cardiovascular System I: Cardiac Biomarkers01:20

Blood Studies for Cardiovascular System I: Cardiac Biomarkers

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:
Troponins
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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Accelerated Diagnostic Pathways for Suspected Acute Coronary Syndrome in Practice: A Randomized Trial of 0/1-Hour vs 0/3-Hour Troponin Testing.

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Modifiers of the effectiveness of point-of-care troponin testing and determinants of concordance between diagnostic pathway recommendations and disposition in patients with chest pain: a post hoc analysis of a randomised controlled trial.

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Related Experiment Video

Updated: Jul 16, 2026

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

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Published on: December 28, 2012

The Evolution of Accelerated Diagnostic Protocols for Suspected Myocardial Infarction.

James Hatherley1,2, Paul Collinson3, Tarek Abuzahra1

  • 1Department of Cardiology, Liverpool University Hospital NHS Foundation Trust, Liverpool L7 8YE, UK.

Journal of Clinical Medicine
|July 15, 2026
PubMed
Summary

High-sensitivity cardiac troponin assays have improved, but assessing chest pain patients with these tests varies. This review examines accelerated diagnostic protocols (ADPs) for improved emergency department efficiency and patient safety.

Keywords:
accelerated diagnostic pathwaysacute coronary syndromecardiac biomarkersmyocardial infarctiontroponin

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Area of Science:

  • Cardiology
  • Biochemistry
  • Emergency Medicine

Background:

  • Significant advancements in cardiac troponin analytic precision over three decades.
  • Widespread adoption of high-sensitivity cardiac troponin (hs-cTn) assays.
  • Variability exists in clinical application for acute chest pain assessment using hs-cTn.

Purpose of the Study:

  • To review the historical development of cardiac troponin assays.
  • To detail the evidence supporting various decision rules for acute chest pain.
  • To focus on specific accelerated diagnostic protocols (ADPs).

Main Methods:

  • Review of historical data and clinical evidence for cardiac troponin testing.
  • Analysis of decision rules including single sample rule-out/rule-in and ADPs.
  • Specific focus on European Society of Cardiology (ESC) 0/1 h and 0/3 h ADPs, and the high-STEACS ADP.

Main Results:

  • The ESC 0/3 h ADP shows potentially reduced rule-out safety compared to ESC 0/1 h and high-STEACS ADPs.
  • High-STEACS ADP demonstrated strong performance in its validation cohort but less impressive external validation in the US.
  • The ESC 0/1 h pathway exhibits robust rule-out performance, partly due to its observational zone.

Conclusions:

  • Different ADPs for hs-cTn in acute chest pain assessment have varying safety and performance profiles.
  • Further investigation into the external validation of the high-STEACS ADP is warranted.
  • Real-world implementation studies are needed to compare ADP impacts on Emergency Department efficiency and clinical decision-making safety.