From the Guidelines
Yes, a patient can have persistently elevated troponin levels for a month without other clear cardiac abnormalities. This phenomenon, sometimes called chronic troponin elevation, can occur due to several non-acute coronary syndrome causes. Common explanations include chronic kidney disease (as troponin is cleared by the kidneys), chronic heart failure (even when compensated), structural heart disease, pulmonary hypertension, or chronic inflammatory conditions 1. Other potential causes include certain medications, endocrine disorders like hyperthyroidism, infiltrative diseases, or chronic respiratory failure.
When encountering persistent troponin elevation, clinicians should perform a comprehensive cardiac evaluation including:
- Echocardiography
- Stress testing
- Possibly cardiac MRI to rule out occult cardiac disease Serial measurements showing stable elevated levels (rather than a rising and falling pattern) support a chronic condition rather than acute injury. Management should focus on identifying and treating the underlying cause rather than assuming an acute cardiac event. Patients with chronic troponin elevation generally require regular follow-up to monitor for any changes that might indicate a new cardiac problem superimposed on the chronic elevation 1.
It is essential to note that troponin elevations can be due to various non-cardiac conditions, such as tachyarrhythmia, hypotension or hypertension, cardiac trauma, acute heart failure, myocarditis, and pericarditis, acute pulmonary thromboembolic disease, and severe noncardiac conditions like sepsis, burns, respiratory failure, acute neurological diseases, and drug toxicity 1. Chronic elevations can result from structural cardiac abnormalities, such as left ventricular hypertrophy or ventricular dilatation, and are also common in patients with renal insufficiency 1.
In the context of real-life clinical medicine, it is crucial to prioritize the patient's morbidity, mortality, and quality of life when managing chronic troponin elevation. A thorough evaluation and identification of the underlying cause are essential to provide appropriate treatment and improve patient outcomes.
From the Research
Elevated Troponin Levels
- Elevated troponin levels can signify myocardial damage and raise concern for acute coronary syndrome (ACS) 2.
- However, there are medical conditions that may cause a patient to have chronically elevated troponin levels in the absence of ACS 2, 3.
- These conditions can include pulmonary embolism, sepsis, myocarditis, and acute stroke, among others 4.
Clinical Scenarios
- Elevated cardiac troponin can be found in clinical scenarios beyond obstructive coronary artery disease, making interpretation challenging 3.
- The investigation of the pathophysiologic mechanism leading to the release of cardiac biomarkers is crucial to understand the clinical significance of elevated serum levels 3.
- Potential confounding factors, both cardiac and non-cardiac in etiology, can affect the synthesis and clearance of cardiac biomarkers 3.
Troponin Elevations
- Troponin elevation is commonly found in patients without acute myocardial infarction (AMI) 5.
- Elevated troponin might be associated with greater use of echocardiography, coronary angiography, and percutaneous coronary intervention in primary diagnoses other than sepsis 5.
- Cardiac troponin elevations can be caused by various mechanisms, including necrosis, apoptosis, necroptosis, cell wounds, and decreased clearance 6.
Persistent Elevations
- It is possible for a patient to have persistently elevated troponin levels for a month without any other clear cardiac abnormalities, as there are various conditions that can cause chronically elevated troponin levels 2, 3.
- The presence of elevated troponin levels, even if stable over time, is linked to a poor prognosis 6.