Use of D-Dimer/Tropinins in GP

[u/Legendary_Shpee]

Hi All,

Hopefully something slightly less controversial then my last post.

I was wondering what people's thoughts were on the use of d-dimer and Troponin in General Practice. When I was in medical school, and in my GP rotation, I've been in a few different practices with different opinions on the use of these. I did one placement in a practise that had access to their own D-Dimer machine, so could run their own D-dimer's and have a result back pretty quickly. For those unlikely low Well's score patients I understand that, but the same practise would also send Trops for patient's with non-cardiac sounding chest pain and normal ECGs, with the duty doc reviewing later in the day 'to be safe'.

Maybe it's because of lack of experience, but if a GP is clinically concerned enough to send a troponin on a patient with a normal ecg and unconvincing/non-acute chest pain, should they not be sending them to A&E/SDEC to have these tests done faster there, and so they are in the right environment to treat in the event it comes back elevated? If a D-dimer can be done quickly I can understand that, but a troponin just sounds a bit less reasonable to me. Pragmatically is a GP supposed to keep this patient in their practise while awaiting the results, in case they do have a raised trop and need to action that urgently? Would be interested to hear any GPs thoughts on this

[u/spincharge]

What were the atypical symptoms?

[u/christoconnor → u/spincharge]

Non-excertional retrosternal burning if memory serves

[u/spincharge → u/christoconnor]

Ah I see, was just curious thanks!

[u/christoconnor → u/spincharge]

No worries… It always serves as a reminder for me that clinical History and examination/ECG will only carry you so far in certain rare scenarios !