elevated troponin: what if its not an MI?

20 Jan

QUICK REVIEW:
–Myocardial necrosis indicated by elevated troponin is NOT always due to atherosclerotic CAD

–Troponin has high sensitivity for detecting very small amount of myocardial cell death

–Troponin is released in the blood due to irreversible as well as reversible cell damage AND does ≠ permanent myocyte damage

EXPANDED DIFFERENTIAL:
–Demand ischemia: sepsis/SIRS, hypotension, hypovolemia, SVT/afib, LVH

–Myocardial ischemia: coronary vasospasm, ICH/stroke, ingestion of sympathomimetic agents

–Direct myocardial damage: cardiac contusion, ICD shock, cardiac infiltrative d/o (amyloidosis), chemotherapy, myocarditis/pericarditis, heart transplant

–Myocardial strain: CHF, PE, PHTN, COPD, strenuous exercise

–Chronic renal insufficiency

Submitted by F. DiFranco.

Reference(s): Jeremias A. & Gibson M. Narrative review: alternative causes for elevated cardiac troponin levels when acute coronary syndromes are excluded. Annals of Internal Medicine. 142(9):786-791, May 2005.

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