How suspicious is the history for an acute coronary syndrome? Highly suspicious: typical chest pain (pressure, radiation, exertion-related). Moderately suspicious: mixed or atypical features. Slightly suspicious: chest pain that is mostly non-cardiac in character.
Significant ST depression: new horizontal or down-sloping ST depression >= 1 mm or T-wave inversions in 2 contiguous leads. Non-specific: LBBB, LVH changes, digoxin effect, early repolarization, or unchanged compared to old tracing.
Patient age bracket at time of presentation.
Risk factors include: known hypertension, hypercholesterolemia, diabetes mellitus, current smoking or cessation within 3 months, obesity (BMI > 30), family history of coronary artery disease, and known atherosclerotic disease (prior MI, PCI/CABG, stroke, or peripheral artery disease).
Compare to local laboratory upper reference limit (URL). High-sensitivity troponin or conventional troponin can both be used; compare the result to your lab's normal reference range.