CASE SCENARIO

A 72-year-old man with a history of well-controlled hypertension, stage 3a chronic kidney disease, supraventricular tachycardia, and gout went to the emergency department (ED) after nearly fainting while mowing his lawn. After a long wait, the ED staff took blood, started intravenous fluids, and obtained an electrocardiogram (ECG). A few hours later, the ED physician informed the patient that results of the blood test showed a slightly elevated troponin level, which could suggest a heart attack. The patient told the physician that he felt fine other than still being a bit dizzy; he asked why the blood test was done and what was going to be done about his dizziness. The physician explained that the laboratory tests were routine for someone his age after a near-fainting spell. The physician also told the patient that he would need to stay in the hospital for two more troponin tests and an echocardiogram. Several hours later, a cardiologist informed the patient that he may have had a small heart attack based on the troponin levels but that the ECG and echocardiogram results were normal. The patient was admitted to the hospital overnight for further testing. He was relieved that the heart attack was discovered, but when he asked about the cause of his dizziness, he did not receive any answers.