What does an elevated troponin mean?--An update on the definition of myocardial infarction

Myocardial infarction has a high rate of morbidity and mortality. There are major social, psychological and legal implications associated with the diagnosis of myocardial infarction (MI).

We present three case studies of different chest pain syndromes presenting with serum troponin elevation, and use these cases to form the basis of a review of the updated definition of MI. A practical approach to the diagnosis of myocardial infarction is also discussed.

The measurement of serum troponin levels was a great diagnostic advance and provided powerful prognostic information. Although elevated serum troponin levels were originally considered pathognomonic of MI, it has become clear that highly sensitive troponin assays detected the presence of elevated troponin levels in the absence of MI. This has led to the recent 'Third universal definition of myocardial infarction' consensus document.