Sepsis-induced Cardiomyopathy: This condition is characterized by a reversible depression of myocardial function in the setting of sepsis, which can lead to elevated troponin levels without chest pain. The patient's sepsis and lack of chest pain, combined with elevated troponin levels, make this a highly plausible diagnosis.

Myocardial Injury from Sepsis: Sepsis can cause direct myocardial injury, leading to troponin elevation. This is different from cardiomyopathy in that it may not necessarily involve a global depression of myocardial function but can still result in significant cardiac enzyme elevation.
Type 2 Myocardial Infarction: This occurs when there is an imbalance between oxygen supply and demand, which can happen in sepsis due to hypotension, tachycardia, or anemia, leading to myocardial injury without the classic symptoms of a type 1 myocardial infarction (e.g., chest pain).
Takotsubo Cardiomyopathy: Although less common, stress from sepsis could potentially trigger this condition, also known as "stress cardiomyopathy," characterized by a reversible left ventricular dysfunction.

Pulmonary Embolism: Although the ECG is normal, pulmonary embolism can cause troponin elevation due to right ventricular strain. It's crucial to consider this diagnosis, especially if there are any respiratory symptoms or signs of right heart strain.
Aortic Dissection: This is a life-threatening condition that can cause troponin elevation if the dissection involves the coronary arteries. The absence of chest pain does not rule out this diagnosis, as pain can be atypical or absent in some cases.

Cardiac Contusion: If the patient has experienced any trauma, a cardiac contusion could be a consideration, although this would be less likely without a history of trauma.
Myopericarditis: Inflammation of the myocardium and pericardium can cause troponin elevation. This could be considered if there are other signs of pericardial involvement, such as a pericardial friction rub.
Cardiotoxicity from Medications: Certain medications can cause cardiomyopathy or myocardial injury, leading to elevated troponin levels. Reviewing the patient's medication list is essential to consider this possibility.

Detailed Sepsis History: Understand the source and severity of sepsis, as well as the current management and response to treatment.
Cardiac Risk Factors: Assess for traditional cardiac risk factors (e.g., hypertension, diabetes, hyperlipidemia, smoking) that could predispose to myocardial injury or infarction.
Symptom Review: Beyond chest pain, inquire about dyspnea, palpitations, or syncope that could suggest cardiac involvement.
Medication Review: Examine the patient's medication list for potential cardiotoxic agents.
Physical Examination: Focus on cardiac examination (e.g., murmurs, gallops, signs of heart failure) and signs of sepsis or potential embolic sources.
ECG and Troponin Trending: Continue to monitor ECGs for any changes and trend troponin levels to assess for improvement or worsening.
Echocardiogram: Consider an echocardiogram to evaluate left and right ventricular function, especially if there's suspicion of cardiomyopathy or myocardial injury.