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We report the case of a 54-year-old patient with bilateral silicone breast implants in whom successful implantation of a subcutaneous loop recorder led to the diagnosis that explained her repeated syncopal events.
In the evaluation of patients with symptoms suggestive of acute coronary syndrome (ACS), biomarker testing is best established for cardiac troponins (cTn). As a heart specific marker of myocardial injury, cTn complements the clinical assessment and the 12-lead electrocardiogram in the diagnosis of ACS.
With the introduction of high-sensitivity cardiac troponin (hs-cTn) assays, reliable measurement of cTn concentrations in the normal range became possible, which increased diagnostic accuracy for myocardial infarction (MI) at presentation. Recent studies showed that single measurements of hs-cTn concentrations allow to predict MI with high probability and to identify high-risk patients who may benefit from early rhythm monitoring and/or invasive management. Novel hs-cTn assays are continuously developed and clinically validated. Their clinical use embedded in diagnostic strategies facilitates the early triage of patients presenting with chest pain to the emergency department. Accordingly, the European Society of Cardiology recommends such strategies with a class I recommendation. Newer evidence suggest that the clinical use of these strategies is also safe in the elderly, a patient population with high prevalence of ACS.
