Can Acute Heart Attack Be Ruled Out Without Imaging Tests?

Usually, when a patient presents to the emergency room with chest pain, doctors want to rule out a heart attack. They aren’t looking for heart disease, but rather, heart attack. Often, a patient is admitted to the hospital for a number of tests, which may include imaging such as an echocardiogram and the highly invasive catheter angiogram.

However, researchers at Researchers at Karolinska Institutet in Sweden have developed a much simpler, faster and cheaper way to rule out a heart attack in the ER in those with chest pain. This simple method has been shown to reduce the number of hospital admissions and costly tests — by 10 to 20 percent.

Heart attack is difficult to quickly rule out.

What typically happens is that a significant number of patients end up being admitted, undergoing all sorts of tests, only to be discharged with a clean bill of heart health. This was the case with my mother’s hospital roommate — an obese woman who’d had chest pain. She was discharged, after undergoing expensive tests, with nothing found wrong with her heart. These kinds of admissions drain hospital resources unnecessarily.

Dr. Dina Melki with the Karolinska University Hospital’s cardiology clinic presented a doctoral thesis of her new, simple method of ruling out heart attack.

The method includes a blood draw for the patient’s troponin levels, but also along with a risk-score system that covers the patient’s ECG results, age and medical history.

Dr. Melki reported that this method enabled doctors to rule out major acute coronary disease (which includes heart attack) in 60 percent of patients, and within their first two hours of ER arrival. This means less drain on hospital resources.

“So 10 to 20 percent of those kept in today could go home instead,” says Dr. Melki in the thesis.

In the case of my mother, she was admitted to the hospital solely on an elevated troponin result. This really got the doctor’s attention: “We’re going to have to admit you.”

WARNING: My mother refused and I had to talk her into the admission. I’m a strong-willed person who doesn’t like to lose a case in which I think I’m right.

Had I backed down, my mother would have had a massive heart attack soon after — this conclusion of mine is based upon the consensus of two cardiologists and a cardiothoracic surgeon who informed me that evening that if my mother went home, she’d probably have a “massive heart attack” within a week. Trust your gut instinct when it comes to a family member — or yourself!


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