Quiz: In the Era of High-Sensitivity Troponin, Does Unstable Angina Still Exist?

1. A patient has a chest pain history highly concerning for acute ischemia but hs-troponins remain below the 99th percentile with no significant delta. Which statement is most accurate?

ACS is ruled out; discharge is appropriate if there is no STEMINSTEMI is ruled out, but ACS can still be presentUnstable angina is an outdated diagnosis and should not be usedA normal troponin excludes clinically important coronary disease

2. Which of the following best reflects the correct framework for diagnosing and managing suspected ACS in the ED?

Troponin aloneECG (STEMI yes/no) plus troponinHistory, ECG interpretation, and biomarkers integrated over timeHEART score alone

3. A 70-year-old with ongoing chest discomfort has an initially nondiagnostic ECG and a “negative” hs-troponin at 3 hours from symptom onset. What is the most appropriate next step if your clinical concern remains high?

Discharge with outpatient follow-up because the protocol is negativeRepeat ECGs and continue observation with reassessmentStop repeating ECGs because STEMI would have declared itself on the first tracingIgnore symptom evolution unless the troponin crosses the 99th percentile

4. Which statement best describes unstable angina in modern terminology?

Myocardial infarction with a small troponin riseTransient ischemia without detectable myonecrosis on biomarkersST elevation without symptomsA historical term no longer included in ACS

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