An emergency medicine approach to troponin elevation due to causes other than occlusion myocardial infarction
Brit Long1, Drew A Long1, Lloyd Tannenbaum1
1Brooke Army Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
Insights
Troponin elevation indicates myocardial injury but is not exclusive to occlusion myocardial infarction (OMI). Emergency clinicians must consider various cardiac and non-cardiac causes to avoid misdiagnosis and ensure patient safety.
Area of Science:
- Cardiology
- Emergency Medicine
- Biomarker Analysis
Background:
- Troponin is crucial for diagnosing acute coronary syndrome (ACS) and occlusion myocardial infarction (OMI).
- Elevated troponin levels can occur in conditions beyond OMI.
- Understanding differential diagnoses for troponin elevation is vital in critical care.
Purpose of the Study:
- To provide emergency clinicians with a focused evaluation of troponin elevation in patients with myocardial injury.
- To differentiate OMI from other causes of elevated troponin.
- To guide appropriate clinical assessment and diagnosis.
Main Methods:
- Narrative review of existing literature.
- Focused evaluation of clinical scenarios involving troponin elevation.
- Emphasis on differential diagnosis in critical illness.
Main Results:
- Troponin elevation signifies myocardial injury, not solely OMI.
- Numerous cardiac (heart failure, dysrhythmia) and non-cardiac (pulmonary embolism, sepsis, stroke) conditions can elevate troponin.
- Elevated troponin is generally associated with poorer patient outcomes.
Conclusions:
- Troponin elevation is a marker of myocardial injury with diverse causes.
- Clinical context, symptoms, ECG, and ultrasound are essential for accurate diagnosis.
- Misdiagnosis of OMI can lead to patient harm and delayed treatment of other conditions.
Introduction:
Troponin is an integral component of the evaluation for acute coronary syndrome (ACS) and occlusion myocardial infarction (OMI). However, troponin may be elevated in conditions other than OMI.
Objective:
This narrative review provides emergency clinicians with a focused evaluation of troponin elevation in patients with myocardial injury due to conditions other than OMI.
Discussion:
ACS includes the diagnosis of myocardial infarction (MI), which incorporates assessment for elevated troponin. Troponin I and T are the most common biomarkers used in assessment of myocardial injury and may be released with myocyte injury and necrosis, myocyte apoptosis and cell turnover, and oxygen supply demand mismatch. Troponin elevation is a reflection of myocardial injury, and many conditions associated with critical illness may result in troponin elevation. These include cardiac and non-cardiac conditions. Cardiac conditions include heart failure, dysrhythmia, and dissection, while non-cardiac causes include pulmonary embolism, sepsis, stroke, and many others. Clinicians should consider the clinical context, patient symptoms, electrocardiogram, and ultrasound in their assessment of the patient with troponin elevation. In most cases, elevated troponin is a marker for poor outcomes including increased rates of mortality.
Conclusions:
Troponin can be elevated in many critical settings. The causes of troponin elevation include cardiac and non-cardiac conditions. Clinicians must consider the clinical context and other factors, as an inappropriate diagnosis of OMI may result in patient harm and misdiagnosis of another condition.
More Related Videos
07:40Impact of High-intensity Interval Exercise and Moderate-Intensity Continuous Exercise on the Cardiac Troponin T Level at an Early Stage of Training
Published on: October 10, 2019
10:12A Sensitive and Specific Quantitation Method for Determination of Serum Cardiac Myosin Binding Protein-C by Electrochemiluminescence Immunoassay
Published on: August 8, 2013
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:14Myocarditis III: Medical Management
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:27Myocarditis II: Clinical Features and Diagnostic Tests