“Troponin-negative chest pain”—a diagnostic evasion?

Having completed attachments in acute medicine and cardiology, I have seen quite a few patients presenting with chest pain. In the vast majority of cases, the diagnosis is acute coronary syndrome, but I have also seen patients with diagnoses of pericarditis, aortic stenosis, aortic dissection, and pulmonary embolism to name but a few examples.

However, I have also seen many patients who present with chest pain that has the appearance of an acute cardiac …