Regarding evaluation of suspected stable angina, which statement is true?

• A. CXR is the primary test to diagnose stable ischemic heart disease
• B. Troponin is always elevated in stable angina
• C. Serum troponin can be normal in stable angina
• D. Coronary angiography is the first test to diagnose stable angina

Answer: (C)

In stable angina, there is a mismatch between oxygen supply and demand that causes chest pain during activity, but there is no ongoing myocardial injury. Because of this, serum troponin levels can be normal in stable angina; troponin rises with myocardial necrosis, as seen in acute coronary syndromes. That’s why troponin isn’t used to diagnose stable ischemic heart disease on its own. The diagnostic approach focuses on detecting inducible ischemia with noninvasive testing (like exercise ECG, sometimes with imaging). Coronary angiography isn’t the first test; it’s reserved for high-risk findings on noninvasive testing or when revascularization is being considered. Chest X-ray isn’t the primary test for this diagnosis. So the statement that troponin can be normal in stable angina is the true one.