This month’s column takes a slight detour from the electrocardiogram (ECG) to look at the closely related topic of interpretation of serum cardiac troponin (cTn) elevation. One of the challenges of ECG interpretation for coronary disease is the lack of specificity and sensitivity of the 12-lead ECG. Statistically, the ECG by itself frequently fails to rule in myocardial infarction (MI) when present and fails to rule out MI when not present. Except for the case of frank ST-segment elevation MI (STEMI), the diagnosis of acute coronary syndrome (ACS) depends on a combination of indicators, such as ECG, physical examination, imaging, history, and risk factor assessment. Working as acute and critical care nurses, we often find ourselves involved in the collection and interpretation of biomarkers, followed by our involvement in the rapid treatment of patients with ACS.

Various biomarkers, including creatine kinase, lactate dehydrogenase, myoglobin, heart-type fatty acid binding protein (H-FABP),...

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