A patient has negative EKG but positive blood work. Which diagnosis is most appropriate?

A patient has negative EKG but positive blood work. Which diagnosis is most appropriate?

• A. NSTEMI
• B. No MI
• C. STEMI
• D. Angina

Answer: (A)

The key idea is that myocardial infarction can be diagnosed when cardiac biomarkers are elevated, even if the EKG doesn’t show ST-segment elevations. When troponin or other markers are positive, it indicates myocardial injury, so a patient with chest pain and a normal or non-diagnostic EKG is diagnosed with an NSTEMI rather than a STEMI. The ST elevations on the EKG would point to STEMI, while absence of biomarker elevation would point toward no MI, and chest pain without biomarkers would suggest unstable angina. Here, the positive blood work confirms myocardial injury despite a negative EKG, so the appropriate diagnosis is NSTEMI.

The key idea is that myocardial infarction can be diagnosed when cardiac biomarkers are elevated, even if the EKG doesn’t show ST-segment elevations. When troponin or other markers are positive, it indicates myocardial injury, so a patient with chest pain and a normal or non-diagnostic EKG is diagnosed with an NSTEMI rather than a STEMI. The ST elevations on the EKG would point to STEMI, while absence of biomarker elevation would point toward no MI, and chest pain without biomarkers would suggest unstable angina. Here, the positive blood work confirms myocardial injury despite a negative EKG, so the appropriate diagnosis is NSTEMI.