NEW-- Update on the update on the notion that Trump had to go to hospital for cardiac emergency

[elias7]

24. Not so fast doc...

The value of cardiac enzymes is in how long a patient has had chest pain.

Troponin tends to take upwards of 4 hours to become measurably elevated in the blood. The current standard in EDs is drawing a second troponin at 6 hours of symptom onset.

So if someone had chest pain for 6 hours and has an ECG that is unchanged from baseline, and does not have a “great story”, e.g. exertional symptoms that come with activity, resolve with rest, or other suspiciously cardiac sounding history, THEN a single troponin could effectively rule out a cardiac event.

An indeterminant troponin (varies with different labs, perhaps 0.4-0.12) would be extremely concerning if someone had chest pains for say, one hour; possibly concerning if someone had pains for 3-4 hours. Either way, serial enzymes (usually 2 more, not 3) would be required. If enzymes were flat, look for alternative explanations of indeterminate levels, e.g. chronic kidney disease.

If Trump had chest pains for an hour or two, he would require at least a second troponin at 6 hours.

I do agree, however, that if Trump had any suspicion of active coronary disease, the ordeal would not have been over in one day.