This article is about how to approach ischemia evaluation for the “non-cardiac” critically ill patient (someone admitted for a problem such as sepsis, stroke, or DKA). This is tough. We want to be thorough enough not to miss significant infarctions. However, excessive testing risks over-diagnosis of ischemia, leading to a host of iatrogenic harms.

• Don’t order a troponin level unless you truly suspect that the patient is having a myocardial infarction.
• Don’t order a troponin level without getting an EKG as well.
• Consider echocardiography as a diagnostic tool to evaluate for plaque-rupture MI (type-I MI).
• Avoid heparin infusions, with consideration of 2.5 mg fondaparinux instead.
• Don’t be surprised when your critically ill patient is found to have an elevated troponin level – this is extremely common among ICU patients

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