Any person in this particular age group that presents with any kind of chest pain deserves to have a full cardiac workup. In this case, it is not completely clear whether or not this person's chest pain is due to a cardiac condition or not. Certainly it is encouraging that the EKGs were normal and also that the CKMB was low. The fact that the troponin was slightly elevated needs to be explained. Troponin should be undetectable in the blood for most people. Other than a heart attack, the only other conditions that can cause an elevation of troponin is renal failure
. If this person does not have renal failure, then I would be concerned that this troponin elevation does represent a very very small heart attack. Most physicians will probably take this patient directly to cardiac catheterization
to look for causes of this problem. If the troponin elevation was felt to be due to something else, such as renal failure, then the next step might be for this patient to undergo a stress test. In either case, I think that this person needs to be referred to a cardiologist
. He or she will be able to review the data from the emergency department, examine this person's past medical history, and decide what the best course of action should be.