II. Physiology: Dynamics

  1. Rises: 2-4 hours (but may be delayed to 8-12 hours in minor injury)
  2. Peaks: 12-24 hours
  3. Duration: 14 days (in large Myocardial Infarction)

IV. Causes: Increased Troponin

V. Approach: Precautions

  1. Obtain Troponin for risk stratification when pretest probability of Acute Coronary Syndrome is high
    1. Ultrasensitive Troponin T has a high False Positive Rate
    2. Positive Troponin In low probability Chest Pain
      1. Subjects that patient to possibly unnecessary stress testing (in some cases angiogram)
  2. Interpret Troponin In context of history, exam and Electrocardiogram
    1. A normal Troponin does not exclude Acute Coronary Syndrome
      1. Negative Troponin does not negate a concerning history or clinical findings
    2. An abnormal Troponin In the absence of other clinical findings does not equal Acute Coronary Syndrome
  3. Compare Troponin level to prior Troponin levels and establish a baseline
    1. Mild chronically elevated Troponin Is common in Chronic Kidney Disease and Congestive Heart Failure
    2. Obtain a second Troponin In 4-6 hours
      1. Establish a trend in mildly elevated Troponin levels despite other reassuring findings
  4. Troponin Increase suggests myocardial cell injury (outside of Chronic Kidney Disease)
    1. First exclude Acute Coronary Syndrome
    2. Next optimize management of conditions with increased myocardial oxygen demand (e.g. CHF, Sepsis)
    3. Finally, consider Troponin Increase a potential marker for worse prognosis in acute presentations (e.g. CVA)
  5. Biotin (High dose, >5000 mcg/day) falsely lowers Troponin

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Troponin (C0041199)

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
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, トロポニンNOS, トロポニン
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.