A physician recently emailed me with a question (paraphrasing): “Our lab recently switched over to using the new highly sensitive troponins’ and we’re confused. What do we do with a positive troponin?”

During the past year, I’ve received many questions at conferences or via email from emergency physicians regarding the utility of the CK-MB. “What do I do when the CK-MB is high but the TN is normal?” or “Why don’t the cardiologists care about the elevated CK-MB?” or “Why is my lab getting rid of the CK-MB?” For quite some time now, these questions have reminded me of the epic movie Titanic.

A 37-year-old man presented to the emergency department with severe respiratory distress. He reported a history of hypertension, diabetes and end-stage renal failure for which he received hemodialysis three times per week. However, he admitted to missing his last two dialysis sessions.