The quest for diagnostic certainty: an unreal expectation in a real world

When is an infarct not an infarct? When it is an infarctlet, a necroset or a troponinosis.1 The advent of the cardiac-specific troponins as diagnostic tests has created confusion in the minds of some cardiologists. The fact that cardiac troponins may be used to diagnose previously unsuspected myocardial damage in patients presenting with acute coronary syndromes, when acute myocardial infarction (AMI) has been ruled out by conventional World Health Organization criteria, has been amply demonstrated since the original report by Hamm et al.