Presenting complaint             1st troponin 2nd troponin Final diagnosis ACS started? Abdominal pain Negative N/A Gastroenteritis NO Right arm pain Negative N/A Off legs NO Reduced mobility Negative N/A Orthostatic hypotension NO Collapse Negative N/A Postural hypotension NO Collapse 0.45 N/A Subarachnoid haemorrhage NO Vomiting Negative N/A Large intracranial bleed NO Headache Negative N/A Headache NO Slurred speech Negative N/A Renal failure NO Right sided weakness Negative N/A Atrial fibrillation NO Fall 0.21 1.52 Mechanical fall YES Fall Negative N/A Fractured left neck of femur NO Breathlessness 0.54 N/A Chest infection NO Collapse 0.19 0.96 Dehydration NO Palpitations and dizziness Negative N/A Palpitations NO Fall Negative N/A Mechanical fall NO Collapse 0.39 0.54 Dehydration YES Collapse 0.07 0.12 Aortic dissection NO Epigastric pain 0.06 0.04 Urinary retention YES Breathlessness Negative N/A Chronic bronchitis NO Collapse 0.37 0.4 Severe asthma NO Generally unwell Negative N/A Alcohol withdrawal NO Epigastric pain Negative Negative Biliary colic NO

Table 3: Inappropriate troponin tests in 22 patients on two 24- audit days (First Cycle). A negative test corresponds to normal values i.e. Troponin< 0.04.