From the Guidelines
Troponin elevation can be caused by various conditions beyond myocardial infarction, including tachyarrhythmias, heart failure, hypertensive emergencies, critical illness, myocarditis, Takotsubo syndrome, and valvular heart disease.
Causes of Troponin Elevation
- Cardiac conditions:
- Myocardial infarction
- Myocarditis
- Pericarditis
- Cardiac contusion
- Heart failure
- Hypertrophic cardiomyopathy
- Aortic dissection or severe aortic valve disease
- Non-cardiac conditions:
- Severe respiratory failure
- Sepsis
- Acute neurological diseases (e.g., stroke, subarachnoid hemorrhage)
- Infiltrative diseases (e.g., amyloidosis, sarcoidosis)
- Drug toxicity
- Burns (affecting >30% of body surface area)
- Rhabdomyolysis
- Renal failure
- Extreme exertion
- Pulmonary embolism or severe pulmonary hypertension
- Critically ill patients
- Inflammatory diseases As noted by 1, cardiac troponin elevations can occur in various cardiac pathologies other than myocardial infarction, and it is essential to consider these alternative diagnoses when interpreting troponin results. Additionally, 1 highlights that troponin elevations can be caused by a range of non-cardiac conditions, including severe respiratory failure, sepsis, and acute neurological diseases. The diagnosis of myocardial infarction requires a rise and/or fall in troponin values, with at least one value above the decision level, as stated in 1 and 1.
From the Research
Causes of Troponin Elevation
Troponin elevation can be caused by various cardiac and non-cardiac conditions. Some of the causes include:
- Cardiac conditions:
- Non-cardiac conditions:
Mechanisms of Troponin Elevation
The mechanisms of troponin elevation are numerous and not limited to ischemic necrosis of cardiac myocytes 4. Troponin elevation can occur due to myocyte injury and necrosis, myocyte apoptosis and cell turnover, and oxygen supply demand mismatch 2.
Diagnostic Consideration
Clinicians should consider the clinical context, patient symptoms, electrocardiogram, and ultrasound in their assessment of the patient with troponin elevation 2. In children and adolescents, troponin elevation may be associated with many cardiac and non-cardiac pathologies, and the most common pathologies in cardiac etiology are myopericarditis and perimyocarditis 5.