ECG Basics and Fundamentals: does negative troponin ACS still exist?

ECG Weekly Workout with Dr. Amal Mattu


A 60-year-old male with PMHx of hyperlipidemia presents to the emergency department with midsternal chest pain (tightness), nausea, and diaphoresis. Symptoms have been intermittent, occur with walking and resolve with rest. He is hypertensive with otherwise normal vital signs. The following ECG is obtained on arrival:

Before watching this week’s video, ask yourself these questions:

  1. What ECG abnormalities do you notice?
  2. The patient’s initial troponin is negative, what would be your next step in management be?
  3. How would your management change if the patient had two normal troponins and no dynamic ECG changes at a 3-hour interval?