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Troponin
Aka: Troponin, Troponin Assay, Increased Troponin Causes, Causes of Abnormal Troponin
- See Also
- Serum Cardiac Markers
- Troponin T
- Troponin I
- Ultrasensitive Troponin T (hs-cTnT)
- Acute Coronary Syndrome
- 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)
- Physiology: Subunits
- Troponin T
- Troponin I
- Ultrasensitive Troponin T (hs-cTnT)
- 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
- Chronic Renal Failure
- Hypoxia
- Pulmonary Embolism
- Pulmonary Hypertension
- Chemotherapy
- Cerebrovascular Accident
- Subarachnoid Hemorrhage
- Aortic Dissection
- Burn Injury
- Acute Respiratory Distress Syndrome (ARDS)
- Sepsis
- Severe Anemia
- Shock
- References
- Agewall (2011) Eur Heart J 32(4): 404-11 [PubMed]
- 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
- 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
- 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]