Heart Care

New Strategy May Find Heart Attacks Quickly

Millions of Americans end up in the ER each year with chest pain, and doctors need to know as soon as possible if that chest pain means a heart attack. A common blood test may be able to provide a definitive answer within an hour.

Photo of ER door open and facing an ambulance

In a recent study, the test, called high-sensitivity cardiac troponin (hs-cTn), appeared to improve the early diagnosis of heart attacks for people who came to the ER complaining of chest pain.

Cardiac troponins are chemicals called enzymes that appear in the blood when heart muscle dies - a common result of a heart attack, says Hal Chadow, M.D., at Brookdale University Hospital and Medical Center in New York City. Dr. Chadow was not part of the study.

Although a different troponin test has been used for more than a decade, it can't detect minute levels of troponins, which the new high-sensitivity test can.

Chest pain in the ER

A Swiss team led by Tobias Reichlin, M.D., of University Hospital Basel, tracked nearly 900 patients who came to the ER with severe chest pain. The final diagnosis for almost 150 was confirmed as a heart attack.

About half of all the patients were assessed using the new troponin test in addition to an electrocardiogram and physical exam, which were done on all patients.

The new testing protocol measured the patients' troponin value when they first arrived, and over the next hour.

Using this method, the researchers ruled out heart attack in 60 percent of the patients, found evidence of heart attack in 17 percent, and put the remaining 23 percent into a group to be "observed" over the next hour.

Differing survival rates

Among patients who did not have a heart attack, the 30-day survival rate was 99.8 percent; among those who were placed under observation, the survival rate was 98.6 percent. In those who had a heart attack, the survival rate was 95.3 percent.

Dr. Reichlin's team found that using the combo of tests not only appeared to be safe, but significantly shortened the time needed to figure out if the patient had suffered a heart attack. The team also believes that this test could avoid the need for prolonged monitoring and multiple blood tests in three of four patients who come to the ER with chest pain.

Although troponins are often higher in people who have had a heart attack, they also can be linked to other conditions such heart failure, clots in the lungs, and stroke, which is why some doctors are calling for caution.

One drawback

Robert Glatter, M.D., at Lenox Hill Hospital in New York City, is concerned that doctors who rely on the troponin test might miss other potentially lethal heart conditions.

He says the high-sensitivity troponin test is not just a test to 'rule in' or 'rule out' heart attack. "Instead, they are a valuable tool to risk-stratify patients with chest pain who may have a number of potentially lethal conditions," he says.

Drs. Glatter and Chadow agree that more studies are needed to confirm the results of the study and to better determine the benefits of troponin testing.

The study was published in the New England Journal of Medicine.

Always talk with your health care provider to find out more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)

American Heart Association - Heart Attack

National Heart, Lung, and Blood Institute - How Is a Heart Attack Diagnosed?

October 2012

Thriving After a Heart Attack

If you've had a heart attack, you're probably wondering how your life is going to change.

Over the long term, your quality of life is tied to how severe your heart attack was and how it was treated. Beyond that, any change will depend largely on you. If you make it happen, your life can be healthier and more active than before.

The first step is to work with your doctor to find the cause of your heart attack and find ways to reduce your risk for another heart attack.

After a first heart attack, the risk for another heart attack increases two- or three-fold. That doesn't mean, though, that the second heart attack has to happen. Here are several strategies to help make your life healthier:

  • Stop smoking

  • Change to a healthier diet

  • Become more physically active

  • Take your medicine as directed by your doctor

You may need surgery to fix damaged heart muscle or angioplasty or surgery on the blood vessels that put you at risk. But surgery by itself is never enough. Lifestyle changes are also necessary.

Always talk with your health care provider to find out more information.

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