When cardiac CT is requested for chest pain, the clinical question changes the scan. A patient with raised troponin and no obstructive coronary disease still has myocardial injury that needs an explanation, and a coronary-only protocol cannot provide one.
Checking the request for troponin, ECG changes and symptom timing before the scan lets the protocol include delayed acquisition where myocardial characterisation might be needed, and lets the report say clearly whether a non-coronary cause was looked for.
- Check the troponin result and timing on chest pain CT requests before choosing the protocol.
- Discuss adding delayed imaging with the cardiology team when troponin is raised.
- State in the report whether myocardial tissue was assessed.
- Recommend cardiac MRI when CT is negative for coronary disease and injury is unexplained.
Why it matters
A coronary-only scan answers half the question in a patient with myocardial injury.
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