title: Cardiac markers protocols in a chest pain observation unit.
abstract: The use of cardiac markers to identify high-risk patients in the observation unit is undeniable. As the literature reviewed here reveals, the history and ECG miss a significant portion of patients with acute cardiac ischemia. It appears that acute MI and some high-risk "unstable angina" observation unit patients can be identified within 6 hours of hospital presentation using a combination of cardiac markers. Testing these patients soon after symptom onset or on arrival in the ED for myoglobin, CK-MB subforms, or CK-MB delta appears to provide the best diagnostic usefulness. For testing later in the clinical course, CK-MB troponin I, or troponin T are of clear diagnostic and prognostic value. The markers currently used are unable to identify the significant subset of patients with "non-AMI" coronary syndromes, however. These patients require further testing with appropriate noninvasive or invasive diagnostic studies.
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine,Detriot,  Michigan USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: O'Neil
authors.forename: M A
authors.initials: MA
authors.lastname: Ross
mesh_terms: D015415:Biomarkers / Q000032:analysis*; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis*; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D017408:Guidelines as Topic; D006757:Hospital Units; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D019370:Observation / Q000379:methods*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014481:United States
chemical_list: D015415:Biomarkers