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The Dilemma Behind Negative Troponin: A Case Report

Nava R Sharma1, Bharosa Sharma2, Madalasa Pokhrel3

  • 1Medicine, Manipal College of Medical Science, Pokhara, NPL.

Cureus
|March 6, 2023
PubMed

Insights

Acute coronary syndrome (ACS) can occur despite negative troponin tests. This case highlights rare instances of cardiac injury missed by standard troponin assays, even with repeated testing.

Area of Science:

  • Cardiology
  • Biomarker analysis

Background:

  • Acute coronary syndrome (ACS) is a leading cause of death in the US.
  • Cardiac ischemia results from an oxygen supply-demand mismatch.
  • Troponin testing offers high sensitivity (>99%) for diagnosing cardiac injury.

Observation:

  • A patient presented with symptoms suggestive of acute coronary syndrome.
  • Troponin levels were negative on initial and repeat testing.
  • Testing was performed using different methods at two separate medical centers.

Findings:

  • This case demonstrates a rare instance of acute coronary syndrome with persistently negative troponin levels.
  • Standard troponin assays may not detect all cases of cardiac injury.

Implications:

  • Clinicians should consider alternative diagnoses or further investigation in ACS-suspected cases with negative troponin.
  • Further research may be needed to understand and identify troponin-negative myocardial infarction cases.
  • Diagnostic strategies for cardiac ischemia may require refinement.

Keywords:
acute coronary syndrome (acs) and stemicardiac troponinfalse negative troponinst-elevation myocardial infarction (stemi)ventricular thrombus

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