• Ischemia modified albumin
• myocardial ischaemia

Periodically in the course of a medical career a new technological advance occurs that dramatically changes the direction of our patient care. The brief history of emergency medicine has unveiled a few such marvels. Those of us who have been in practice for many years have on occasion boasted to our younger colleagues of the challenges of managing SVTs without adenosine, or diagnosing unconscious patients with no computed tomography scans. The report by Sinha et al on an “Ischemia modified albumin” (IME) assay in this issue of the journal has the potential to create a similar management change for the emergency department care of chest pain patients.¹

Differentiating transient myocardial ischaemia or angina from non-cardiac causes of chest pain is a major diagnostic challenge. Emergency physicians have a very limited number of answers they can provide a chest pain patient. We can identify an acute ST elevation myocardial infarction (MI) through examination of a standard 12 lead electrocardiogram, in most instances. We can also recognise a non-STE MI, and acute coronary syndromes though detection of raised myocardial enzymes. But once we have …