As the years tick by our healthcare systems work harder and harder to ensure that acute coronary syndromes are picked up as they present to our Emergency Departments, the evolution of high sensitivity troponins and their application have been key to this. The utility of a test however is dependant upon it's application to the appropriate patient. In a heavily burdened system it can at times seem sensible to front load tests and 'add on a troponin' before we are even sure the history is consistent with a possible acute coronary syndrome. But is this a safe approach for our patients and what are the potential consequences? In this podcast we run through a recent paper from the US on the topic. Whilst not the highest level of evidence and also looking at a system not entirely generalisable to the UK, it does highlight the aforementioned concerns and is a useful reminder to consider our approach to testing in patients with chest pain. We are certainly not berating the use of troponin, we just think the paper serves a great reminder that testing must be appropriately applied. Enjoy, and as ever we'd love to hear your feedback! References SIGN ACS Guidelines 2016 RCEMFOAMed SIGN ACS Guidelines Causes of Elevated Cardiac Troponins in the Emergency Department and Their Associated Mortality. Meigher S. Acad Emerg Med. 2016 Cardiac Troponin: The basics from St. Emlyn’s Rick Body via St Emlyns; One high sensitivity troponin test to rule out acute myocardial infarction