India is estimated to have the highest snakebite mortality in the world. World Health Organization (WHO) places the number of bites to be 83,000 per annum with 11,000 deaths. 1 Most of the fatalities are due to the victim not reaching the hospital in time where definite treatment can be administered. In addition, community is also not well informed about the occupational risks and simple measures which can prevent the bite. It continues to adopt harmful first-aid practices, such as tourniquets, cutting, and suction. Studies reveal that primary care doctors do not treat snakebite patients mainly due to lack of confidence. 2 At the secondary and the tertiary care level, multiple protocols are being followed for polyvalent anti-snake venom (ASV) administration, predominantly based on western textbooks.

Acute coronary syndrome (ACS) is one of the leading causes of admission to the emergency departments (EDs) worldwide. The diagnosis of ACS involves the evaluation of clinical signs and symptoms, electrocardiographic assessment, and measurement of cardiac circulating biomarkers. In the last 60 years, the use of laboratory markers has changed considerably. Early biomarker assessment has entailed testing for total enzyme activity of aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and creatine kinase (CK) but was highly nonspecific. Soon thereafter, the development of immunoassays, as well as technical advances in automation, allowed the measurements of the CK MB isoenzyme (CK-MB) in mass rather than in activity and myoglobin. Currently, cardiac troponins (CTn) have the highest sensitivity and specificity for myocardial necrosis and represent the biochemical gold standard for diagnosing acute myocardial infarction (AMI). This review provides a chronology of the major events that marked the evolution of cardiac biomarker testing and the development of the relative assays from the first introduction of AST in the 1950s to the last high-sensitivity troponin immunoassays in the 2010s.