From the Guidelines
Troponin elevation can be caused by a wide range of conditions beyond acute coronary syndromes, including myocarditis, heart failure, hypertensive emergencies, critical illness, myocardial contusion, rhabdomyolysis, and severe pulmonary embolism.
Causes of Troponin Elevation
- Cardiac conditions: myocarditis, heart failure, hypertensive emergencies, cardiac contusion, rhabdomyolysis, and severe pulmonary embolism 1
- Non-cardiac conditions: severe respiratory failure, sepsis, acute neurological diseases, and drug toxicity 1
- Chronic conditions: renal failure, infiltrative diseases (e.g. amyloidosis, sarcoidosis), and hypertrophic cardiomyopathy 1
Key Points
- Troponin elevation is not specific to acute coronary syndromes and can be caused by various conditions 1
- A rising and/or falling pattern of troponin values is essential to distinguish acute from chronic elevations 1
- The 99th percentile of the upper reference limit should be used as the decision level for the diagnosis of myocardial infarction 1
- Serial changes in troponin values should be considered in the diagnosis of myocardial infarction, with a change of ≥20% or an absolute increase of high-sensitivity cardiac troponin T values indicating reinfarction 1
From the Research
Causes of Troponin Elevation
Troponin elevation can be caused by various cardiac and non-cardiac conditions. Some of the cardiac conditions that can cause troponin elevation include:
Non-cardiac conditions that can cause troponin elevation include:
- Pulmonary embolism 2, 3, 5
- Sepsis 2, 3
- Stroke 2, 3
- Renal failure 3
- Rhabdomyolysis 3
- Septic shock 3
- Drug intoxications 4
- Carbon monoxide poisoning 4
- Intensive inhalation β agonist use in acute asthma and lower respiratory tract infections 4
Clinical Considerations
It is essential for clinicians to consider the clinical context, patient symptoms, electrocardiogram, and ultrasound when assessing a patient with troponin elevation 2. Elevated troponin levels can be due to a wide array of mechanisms in the absence of myocardial ischemia and injury 6. Therefore, relying solely on troponin levels to diagnose myocardial ischemia can lead to unnecessary and expensive invasive testing 6.
Diagnostic Approach
In children and adolescents, troponin elevation can be associated with many cardiac and non-cardiac pathologies 4. The most common pathologies in cardiac etiology are myopericarditis and perimyocarditis, and can be diagnosed by history, physical examination, ECG, and echocardiography 4. In most cases, elevated troponin is a marker for poor outcomes, including increased rates of mortality 2.