Etiology of Elevated Troponin
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Demand Ischemia
- Sepsis/SIRS: due to myocardial depression and supply-demand mismatch
- Hypotension: due to decreased perfusion pressure
- Hypovolemia : due to decreased CO
- SVT/AF: due to supply-demand mismatch
- LVH: due to subendocardial ischemia
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Myocardial Ischemia
- Sympathomimetics: due to adrenergic effects
- Coronary Vasospasm: due to prolonged ischemia with myonecrosis
- Intracranial Bleed or CVA: due to autonomic nervous system imbalance
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Myocardial Damage
- Cardiac Contusion: due to trauma
- DC Cardioversion: due to trauma
- Cardiac Infiltrative Disease: due to myocyte compression
- Chemo: due to cardiac toxicity
- Myocarditis: due to inflammation
- Pericarditis: due to inflammation
- Cardiac Transplant: due to inflammation and immune-mediated mechanisms
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Myocardial Strain
- CHF: due to myocardial wall stretch
- PE (elevated trop in 16-50% of Cases): due to RV stretch
- Elevated trop predicts increased PE mortality
- Pulmonary HTN of Any Etiology (elevated trop occurs in 14% of cases): due to pulm HTN -> RV stretch
- Elevated trop is correlated with elevated BNP and worse 2 yr survival
- COPD Exacerbation: due to pulm HTN -> RV stretch
- Elevated trop predicts worse in-hospital mortality
- Strenuous Exercise: due to ventricular stretch
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Other
- CRF/ESRD: unknown mechanism (possibly related to impaired renal trop clearance)
- Duchenne’s Muscular Dystrophy: usually mild elevation (<1.5)