II. Physiology: Dynamics
- Rises: 2-4 hours (but may be delayed to 8-12 hours in minor injury)
- Peaks: 12-24 hours
- Duration: 14 days (in large Myocardial Infarction)
III. Physiology: Subunits
IV. Causes: Increased Troponin
-
Acute Coronary Syndrome (Myocardial Infarction)
- Other causes below are referred to as Myocardial Injury or Troponin Leak
-
Arrhythmia
- Atrial Fibrillation with Rapid Ventricular Rate
- Supraventricular Tachycardia (15-20% of cases)
- Cardiac injury, stress or increased myocardial oxygen demand
- Cardiac procedures
- Chronic Severe Hypertension
- Severe Cardiomyopathy (including Hypertrophic Cardiomyopathy)
- Congestive Heart Failure
- Myocarditis
- Pericarditis
- Marathon Running or other strenuous Exercise
- Cardiac Contusion
- Endocarditis
- Arrhythmia (e.g. PSVT, Atrial Fibrillation with RVR)
- Non-cardiac conditions
- References
V. Approach: Precautions
- Obtain Troponin for risk stratification when pretest probability of Acute Coronary Syndrome is high
- Ultrasensitive Troponin T has a high False Positive Rate
- Positive Troponin In low probability Chest Pain
- Subjects that patient to possibly unnecessary stress testing (in some cases angiogram)
- Interpret Troponin In context of history, exam and Electrocardiogram
- A normal Troponin does not exclude Acute Coronary Syndrome
- Negative Troponin does not negate a concerning history or clinical findings
- An abnormal Troponin In the absence of other clinical findings does not equal Acute Coronary Syndrome
- A normal Troponin does not exclude Acute Coronary Syndrome
- Compare Troponin level to prior Troponin levels and establish a baseline
- Mild chronically elevated Troponin Is common in Chronic Kidney Disease and Congestive Heart Failure
- Obtain a second Troponin In 4-6 hours
- Establish a trend in mildly elevated Troponin levels despite other reassuring findings
-
Troponin Increase suggests myocardial cell injury (outside of Chronic Kidney Disease)
- First exclude Acute Coronary Syndrome
- Next optimize management of conditions with increased myocardial oxygen demand (e.g. CHF, Sepsis)
- Finally, consider Troponin Increase a potential marker for worse prognosis in acute presentations (e.g. CVA)
- Biotin (High dose, >5000 mcg/day) falsely lowers Troponin
VI. References
- Mattu in Majoewsky (2013) EM:Rap 13(9): 5
- Ebell (2000) J Fam Pract 49:550-6 [PubMed]
- Newby (2012) J Am Coll Cardiol 60(23):2427-63 [PubMed]
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Related Studies
| Definition (CHV) | a protein found in muscle that helps it contract |
| Definition (CHV) | a protein found in muscle that helps it contract |
| Definition (MSH) | One of the minor protein components of skeletal muscle. Its function is to serve as the calcium-binding component in the troponin-tropomyosin B-actin-myosin complex by conferring calcium sensitivity to the cross-linked actin and myosin filaments. |
| Definition (CSP) | complex (T,I,C) which mediates actin-myosin contractile phenomena; troponin C, when saturated with calcium, permits myosin to displace tropomyosin from actin filaments. |
| Concepts | Biologically Active Substance (T123) , Amino Acid, Peptide, or Protein (T116) |
| MSH | D014336 |
| SnomedCT | 102680009 |
| Swedish | Troponin |
| Czech | troponin |
| Finnish | Troponiini |
| Russian | TROPONIN, ТРОПОНИН |
| English | Troponin complex, Troponin [Chemical/Ingredient], troponins, troponin, Troponin, Troponin (substance), Troponin, NOS |
| Polish | Troponina |
| Croatian | Not Translated[Troponin] |
| Spanish | troponina (sustancia), troponina, Troponina |
| French | Troponine |
| German | Troponin |
| Italian | Troponina |
| Portuguese | Troponina |
Ontology: Troponin measurement (C0523952)
| Definition (NCI_CDISC) | A measurement of the total troponin in a biological specimen. |
| Definition (NCI) | The determination of the amount of total troponin present in a sample. |
| Concepts | Laboratory Procedure (T059) |
| SnomedCT | 105000003 |
| CPT | 84484 |
| Italian | Troponina, Troponina NAS |
| Dutch | troponine NAO, troponine |
| French | Troponine SAI, Troponine |
| German | Troponin NNB, Troponin |
| Portuguese | Troponina NE, Troponina |
| Spanish | Troponina NEOM, medición de troponina (procedimiento), medición de troponina, Troponina |
| Japanese | トロポニン, トロポニンＮＯＳ, ﾄﾛﾎﾟﾆﾝNOS, ﾄﾛﾎﾟﾆﾝ |
| Czech | Troponin, Troponin NOS |
| English | serum troponin measurement (lab test), serum troponin measurement, serum troponin, troponin level test, Troponin NOS, Measurement of troponin, Troponin Measurement, TROPONIN, Troponin, Troponin measurement (procedure), Troponin measurement, Troponin measurement, NOS, troponin test, Test;troponin |
| Hungarian | Troponin, Troponin k.m.n. |
