Chest Pain Investigation

Question 1

When is a troponin test not indicated in a chest pain patient?

Answer 1

When the time elapsed since the last episode of pain/symptoms is long enough (e.g. 48 hours) such that a troponin test will not be able to distinguish between an MI and angina

Question 2

Why is an echocardiogram not immediately useful in a chest pain patient?

Answer 2

Unless there is a history strongly suggestive of valvular lesion or cardiac structural defect (both of which are detectable on an echo), then it will not be able to identify a potential arrhythmia and is therefore not immediately indicated

Question 3

Why is home oxygen not useful in a cardiac/chest pain patient?

Answer 3

Home O2 is usually prescribed for patients with respiratory disease and/or chronic hypoxia after a full assessment
- a cardiac patient so hypoxic that they need supplemental oxygen should not be sent home

Question 4

What is the most useful test in investigating a history of intermittent “cardiac-like” chest pain?

Answer 4

24-hour ECG

- pain is likely secondary to paroxysmal tachycardia, which is best detected by 24-hour/ambulatory ECG

Question 5

Why is 24hr/ambulatory ECG useful in chest pain secondary to paroxysmal tachycardia? What is an example of an appropriate management plan for this?

Answer 5

Analysis of it will indicate the source of the tachycardia - i.e. supra-ventricular or ventricular (much more serious)
- this will, in turn, also indicate an appropriate management plan that may include permanent pacing to prevent the paroxysmal tachycardias, and hence, the chest pain