From the Guidelines
Elevated troponin levels can be caused by various conditions, including myocardial infarction (MI), myocarditis, cardiac trauma, acute heart failure, tachyarrhythmia, hypotension or hypertension, severe noncardiac conditions such as sepsis, burns, respiratory failure, and acute neurological diseases.
Causes of Elevated Troponin Levels
- Myocardial ischemia: Plaque rupture, intraluminal coronary artery thrombus formation, coronary spasm, or coronary embolism can cause elevated troponin levels 1.
- Myocardial injury: Cardiac contusion, surgery, ablation, pacing, or defibrillator shocks can lead to elevated troponin levels 1.
- Non-ischemic conditions: Myocarditis, Takotsubo syndrome, and stress cardiomyopathy can cause elevated troponin levels 1.
- Chronic conditions: Renal failure, heart failure, and structural cardiac abnormalities such as left ventricular hypertrophy or ventricular dilatation can result in chronic elevations of troponin levels 1.
- Other conditions: Severe pulmonary embolism, pulmonary hypertension, and infiltrative diseases such as amyloidosis or sarcoidosis can also cause elevated troponin levels 1.
Diagnostic Considerations
- A troponin value above the 99th percentile of the upper reference level is required for the diagnosis of myocardial necrosis, along with evidence of a serial increase or decrease ≥20% if the initial value is elevated 1.
- Serial changes in troponin values are important to distinguish acute from chronic elevations, and to diagnose myocardial infarction 1.
- Clinical context is crucial in interpreting elevated troponin levels, as they can be caused by various conditions, and a thorough evaluation is necessary to determine the underlying cause 1.
From the Research
Causes of Elevated Troponin Levels
Elevated troponin levels can be caused by various conditions, including:
- Cardiac conditions such as heart failure, dysrhythmia, and dissection 2, 3
- Non-cardiac conditions such as pulmonary embolism, sepsis, stroke, and renal failure 2, 3, 4
- Myocardial injury due to conditions other than occlusion myocardial infarction 2
- Myocyte apoptosis and cell turnover, and oxygen supply demand mismatch 2
- Non-ischemic cardiac conditions and non-cardiovascular diseases 3
- Chronically elevated troponin levels can be caused by various medical conditions in the absence of acute coronary syndrome (ACS) 5
Clinical Considerations
When evaluating a patient with elevated troponin levels, clinicians should consider the clinical context, patient symptoms, electrocardiogram, and ultrasound to determine the underlying cause of the elevation 2. Elevated troponin levels can be a marker for poor outcomes, including increased rates of mortality 2. Therefore, it is essential to accurately diagnose the cause of the elevation to provide appropriate treatment and avoid misdiagnosis of other conditions 2, 4, 6.