Serum Troponin

Etiology of Elevated Troponin

  • 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
  • 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
  • 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
  • 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
  • Other

    • CRF/ESRD: unknown mechanism (possibly related to impaired renal trop clearance)
    • Duchenne’s Muscular Dystrophy: usually mild elevation (<1.5)