In any case, the rise and fall of troponin, whether above or below the 99% reference, repesents ACS. It is important to note, however, that in ACS, the lower the troponin level, the lower the risk. Nevertheless, a rise and fall like this, even if below the level for diagnosis of MI, indicates ACS and puts the patient at risk of a larger MI and even death.
The patient was in the hospital for several days. He had some episodes of what is described as variously as bundle branch block and as ventricular tachycardia. He had a normal echocardiogram, and a normal stress test EXCEPT that he had runs of V Tach during the test.
An angiogram showed a 90% RCA stensosis. He received a stent.
1. The patient had unstable angina, but without pain.
2. Dynamic ST depression is nearly diagnostic of ischemia
3. Rise and fall of troponins, even if too low to diagnose MI, indicates ischemia and, in the this clinical context, unstable angina.