[Rational use of troponin testing]

Cardiac troponins are sensitive biomarkers of myocardial injury and are widely used in clinical practice. Although troponin testing plays a central role in the diagnosis of myocardial infarction, an elevated troponin level does not necessarily indicate myocardial ischemia. Many cardiac and non-cardiac conditions commonly encountered in internal medicine, including sepsis, severe anaemia, renal dysfunction, inflammatory or immune-mediated diseases, and several metabolic or treatment-related complications, may also be associated with elevated troponin levels. Their interpretation should therefore integrate the clinical presentation, electrocardiographic findings, biomarker kinetics, and the underlying clinical context. This review provides a practical and rational approach to troponin testing in internal medicine, highlighting its main indications and aiming to avoid unnecessary investigations or inappropriate management.