From the Guidelines
Troponin elevation can be caused by various conditions, including myocardial ischemia, myocardial injury, and non-ischemic myocardial damage.
Causes of Troponin Elevation
- Myocardial ischemia-related conditions, such as:
- Plaque rupture
- Intraluminal coronary artery thrombus formation
- Tachy-/brady-arrhythmias
- Aortic dissection or severe aortic valve disease
- Hypertrophic cardiomyopathy
- Cardiogenic, hypovolemic, or septic shock
- Severe respiratory failure
- Severe anemia
- Hypertension with or without LVH
- Coronary spasm
- Coronary embolism or vasculitis
- Coronary endothelial dysfunction without significant CAD 1
- Non-ischemic myocardial damage, such as:
- Cardiac contusion, surgery, ablation, pacing, or defibrillator shocks
- Rhabdomyolysis with cardiac involvement
- Myocarditis
- Cardiotoxic agents, e.g. anthracyclines, herceptin
- Multifactorial or indeterminate myocardial injury
- Heart failure
- Stress (Takotsubo) cardiomyopathy
- Severe pulmonary embolism or pulmonary hypertension
- Sepsis and critically ill patients
- Renal failure
- Severe acute neurological diseases, e.g. stroke, subarachnoid hemorrhage
- Infiltrative diseases, e.g. amyloidosis, sarcoidosis
- Strenuous exercise 1
Key Points
- Troponin elevation is not specific to myocardial infarction and can be caused by various conditions 1
- The distinction between acute and chronic myocardial injury lies in both the magnitude of the troponin concentration and its temporality of change 1
- A rise and/or fall in troponin values with at least one value above the decision level is required to establish the diagnosis of myocardial infarction, coupled with a strong pre-test likelihood 1
From the Research
Causes of Troponin Elevation
Troponin elevation can be caused by various factors, including:
- Sepsis 2, 3, 4
- Hypovolemia 2
- Atrial fibrillation 2
- Congestive heart failure 2, 3
- Pulmonary embolism 2, 4
- Myocarditis 2
- Myocardial contusion 2
- Renal failure 2, 3, 4
- Exercise or physical exertion 5, 4
- Inflammatory heart disease 4
- Acute kidney injury (AKI) 3
Clinical Implications
It is essential to note that troponin elevation does not necessarily indicate the presence of a thrombotic acute coronary syndrome 2, 3. A detailed assessment of symptoms and patient history is crucial for accurate interpretation of a positive cardiac troponin test 5. Elevated troponin levels can be associated with various medical conditions, and identifying the underlying cause is vital for optimal patient management 6, 3. The sensitivity and specificity of troponin I for predicting acute coronary syndrome (ACS) were found to be 84.6% and 58%, respectively, in one study 3.