Elevated cardiac troponins: the ultimate marker for myocardial necrosis, but not without a differential diagnosis.

Cardiac troponins are released from myocytes following myocardial damage and loss of membrane integrity. Their significance when diagnosing acute myocardial infarction is immense, e.g., their high sensitivity and specificity for myocardial tissue, the prognostic information they bear, and their role in risk stratification and therapeutic decisions. However, one cannot fully and blindly rely on cTn testing in diagnosing acute MI since many other conditions are associated with elevation of troponin. A review of the literature demonstrates a myriad of such examples including non-thrombotic cardiac injury, systemic diseases and laboratory interferences. Failure to acknowledge the differential diagnosis of elevated troponin may lead to over-diagnosis of MI and, accordingly, misdiagnosis of the real cause. It is of utmost importance that all physicians who measure troponin recognize the possibility of falsely diagnosing Ml and are familiar with the main alternative causes for cardiac troponin elevation.