Introduction: The electrocardiogram (ECG) is the key player in the diagnosis of an acute coronary syndrome. In the light of normal ECG findings, the diagnosis can be missed. The high-sensitive troponin is a necessary laboratory value for patients with uncommon symptoms.
Case presentation: A 53-year-old man without a history of coronary heart disease initially presented to his general practitioner with persistent hiccups for 3 weeks. In the emergency department, the patient complained of nausea and burping. The high-sensitive troponin T was 989 pg/mL and led to the diagnosis of an acute coronary syndrome.
Conclusion: The troponin algorithm helps to identify this patient group, especially in the setting of elevated creatine kinase and lactate dehydrogenase. Awareness of these symptoms can help lead to a timely reperfusion therapy and thus improved outcomes. The 2015 European Society of Cardiology algorithm for troponin may not only help for the initial diagnosis, but rather should be regarded as crucial.
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