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Sunday 5 July 2026

Peer Reviewed

ECG education

Is this an acute coronary syndrome?

Vivienne Miller

Recent articles on:
Acute coronary syndrome

‘Goodnight, sweetheart’: wake up to a new paradigm for lipid-lowering therapy

False-positive cardiac troponin in clinical practice: causes, assessment and implications

Diagnosing chest pain

An ischaemic leg: what is at the heart of the problem?

Acute coronary syndrome: the challenge of identifying low-risk patients

Recent articles on:
Heart diseases

An abnormal ECG and a sudden collapse

Why is this patient feeling faint?

What’s my heart disease risk, doctor? A practical guide to the 2023 Australian CVD risk guideline

Transthyretin cardiac amyloidosis: hiding in plain sight?

Sinus pause and arrest

Abstract

A normal or unchanged ECG does not exclude an acute coronary syndrome.

Key Points

Cardiac symptoms may be atypical so it is wise to always remember this.
A normal or unchanged ECG does not exclude an acute cardiac syndrome.
An acute coronary syndrome requires a serum troponin test for diagnosis if the patient has a left bundle branch block.
If you think it is possible that the patient could have an acute coronary syndrome, do not waste time doing an urgent serum troponin test. The patient needs referral to a hospital centre that can do angiography.
It follows that performing a serum troponin test in general practice is useful only to reassure the doctor and patient that the presentation was definitely not an acute coronary syndrome.
If you request an urgent serum troponin test, ensure you are contactable for notification of the result and to take appropriate action.