Annals for Hospitalists Inpatient Notes - Clinical Pearls—A Middle-Aged Man With Pneumonia and Elevated High-Sensitivity Troponin Levels
Authors: Christopher M. Petrilli, Donald A. Giacherio
Journal: Annals of Internal Medicine (2018)

Web Exclusives16 October 2018Annals for Hospitalists Inpatient Notes - Clinical Pearls—A Middle-Aged Man With Pneumonia and Elevated High-Sensitivity Troponin LevelsChristopher M. Petrilli, MD and Donald A. Giacherio, PhDChristopher M. Petrilli, MDNYU Langone Health, New York, New York (C.M.P.)Search for more papers by this author and Donald A. Giacherio, PhDUniversity of Michigan Medical School, Ann Arbor, Michigan (D.A.G.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-2296 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The patient is a 43-year-old man with a medical history of hypertension and stage 3b chronic kidney disease who presents with cough and subjective fevers. For 3 days before admission, the patient had cough intermittently productive of dark-yellow phlegm, shortness of breath, subjective fevers, increased fatigue, and decreased oral intake. He did not report chest pain, palpitations, nausea, vomiting, diaphoresis, syncope, or lightheadedness. He did not endorse exposure to persons with respiratory illness, or travel.On presentation to the emergency department, the patient was afebrile, heart rate was 90 beats/min, blood pressure was 120/80 mm Hg, respiratory rate was 20 ...References1. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al; Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction. Third universal definition of myocardial infarction. Circulation. 2012;126:2020-35. [PMID: 22923432] doi:10.1161/CIR.0b013e31826e1058 CrossrefMedlineGoogle Scholar2. Twerenbold R, Boeddinghaus J, Nestelberger T, Wildi K, RubiniGimenez M, Badertscher P, et al. Clinical use of high-sensitivity cardiac troponin in patients with suspected myocardial infarction. J Am Coll Cardiol. 2017;70:996-1012. [PMID: 28818210] doi:10.1016/j.jacc.2017.07.718 CrossrefMedlineGoogle Scholar3. Pickering JW, Than MP, Cullen L, Aldous S, Ter Avest E, Body R, et al. Rapid rule-out of acute myocardial infarction with a single high-sensitivity cardiac troponin T measurement below the limit of detection: a collaborative meta-analysis. Ann Intern Med. 2017;166:715-724. [PMID: 28418520]. doi:10.7326/M16-2562 LinkGoogle Scholar4. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al; ESC Scientific Document Group. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267-315. [PMID: 26320110] doi:10.1093/eurheartj/ehv320 CrossrefMedlineGoogle Scholar5. Hollander JE. Managing troponin testing. Ann Emerg Med. 2016;68:690-694. [PMID: 27353283] doi:10.1016/j.annemergmed.2016.05.023 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: NYU Langone Health, New York, New York (C.M.P.)University of Michigan Medical School, Ann Arbor, Michigan (D.A.G.)Disclosures: Authors have disclosures no conflicts of interest. The forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2296.Corresponding Author: Christopher M. Petrilli, MD, NYU Langone Health, 550 First Avenue, New York, NY 10016; e-mail, chris.[email protected]com. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - 16 October 2018 David H. Wesorick and Vineet Chopra Metrics Cited byContemporary NSTEMI management: the role of the hospitalist 16 October 2018Volume 169, Issue 8Page: HO2-HO3KeywordsAcute coronary syndromeChronic kidney diseaseDisclosureFeversHospitalistsMuscle proteinsMyocardial infarctionPneumoniaProteinsTroponin ePublished: 16 October 2018 Issue Published: 16 October 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...