SHOW NOTES: Therapeutic Trials: Maalox relieves pain in 15 percent of cases of ACS. Why? The logical answer is coincidence, so before you order Maalox, ask if the pain is already improving. Do the same for NTG, and you will be less likely to get fooled by coincidences. Second Troponin: Before doing a second troponin, do a second history to nail down the timing and duration as best as possible. Otherwise, you may end up wasting time, or worse, giving yourself false reassurance. Pain Duration: Assume all cardiac chest pain is unstable angina until proven otherwise and that every chest pain patient has episodic pain lasting five-10 minutes, making the troponin and ECG useless.

HEART score: Not as useful if pain has resolved because the troponin and ECG may be useless. Score grouping may also overestimate risk in a patient with a score of 0-1 and underestimate risk in a patient with a score of 3. Use the info in scores, but don’t blindly follow them. Apply logic!