Brit Long1, Drew A Long2, Lloyd Tannenbaum2, Alex Koyfman3. 1. Brooke Army Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States. Electronic address: brit.long@yahoo.com. 2. Brooke Army Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States. 3. The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States.
Abstract
INTRODUCTION: Troponin is an integral component of the evaluation for acute coronary syndrome (ACS) and occlusion myocardial infarction (OMI). However, troponin may be elevated in conditions other than OMI. OBJECTIVE: This narrative review provides emergency clinicians with a focused evaluation of troponin elevation in patients with myocardial injury due to conditions other than OMI. DISCUSSION: ACS includes the diagnosis of myocardial infarction (MI), which incorporates assessment for elevated troponin. Troponin I and T are the most common biomarkers used in assessment of myocardial injury and may be released with myocyte injury and necrosis, myocyte apoptosis and cell turnover, and oxygen supply demand mismatch. Troponin elevation is a reflection of myocardial injury, and many conditions associated with critical illness may result in troponin elevation. These include cardiac and non-cardiac conditions. Cardiac conditions include heart failure, dysrhythmia, and dissection, while non-cardiac causes include pulmonary embolism, sepsis, stroke, and many others. Clinicians should consider the clinical context, patient symptoms, electrocardiogram, and ultrasound in their assessment of the patient with troponin elevation. In most cases, elevated troponin is a marker for poor outcomes including increased rates of mortality. CONCLUSIONS: Troponin can be elevated in many critical settings. The causes of troponin elevation include cardiac and non-cardiac conditions. Clinicians must consider the clinical context and other factors, as an inappropriate diagnosis of OMI may result in patient harm and misdiagnosis of another condition. Published by Elsevier Inc.
INTRODUCTION: Troponin is an integral component of the evaluation for acute coronary syndrome (ACS) and occlusion myocardial infarction (OMI). However, troponin may be elevated in conditions other than OMI. OBJECTIVE: This narrative review provides emergency clinicians with a focused evaluation of troponin elevation in patients with myocardial injury due to conditions other than OMI. DISCUSSION: ACS includes the diagnosis of myocardial infarction (MI), which incorporates assessment for elevated troponin. Troponin I and T are the most common biomarkers used in assessment of myocardial injury and may be released with myocyte injury and necrosis, myocyte apoptosis and cell turnover, and oxygen supply demand mismatch. Troponin elevation is a reflection of myocardial injury, and many conditions associated with critical illness may result in troponin elevation. These include cardiac and non-cardiac conditions. Cardiac conditions include heart failure, dysrhythmia, and dissection, while non-cardiac causes include pulmonary embolism, sepsis, stroke, and many others. Clinicians should consider the clinical context, patient symptoms, electrocardiogram, and ultrasound in their assessment of the patient with troponin elevation. In most cases, elevated troponin is a marker for poor outcomes including increased rates of mortality. CONCLUSIONS: Troponin can be elevated in many critical settings. The causes of troponin elevation include cardiac and non-cardiac conditions. Clinicians must consider the clinical context and other factors, as an inappropriate diagnosis of OMI may result in patient harm and misdiagnosis of another condition. Published by Elsevier Inc.
Entities:
Keywords:
Acute coronary syndrome; Biomarker; Critical illness; Myocardial infarction; Non-occlusion; Occlusion; Troponin; Type 1; Type 2