Just because the Troponin is elevated doesn't mean it is a MI!

January 9, 2013

Most of us associate an elevated Troponin with a cardiac event. What do you do when you find no cardiac cause for the elevation? "Ralph" says: "send'em home their heart is ok." I am sure that none of you will do that, but where do we look, what do we look for? I have listed a few things that will cause elevation of the troponin without specific cardiac damage.
How did I figure this out? Well if you haven't seen by now that Brother Murphy hangs out with Ralph and I on a fairly regular basis, ya need to clean your glasses. If it is weird, uncommon, or "doesn't occur in this population", trust me, the patient will seek me out.
I had a patient present with a Troponin of 3.89 with NO EKG changes, NO chest pain, NO shortness of breath, NO CAD, and NO familial cardiac risk factors. His CKMB was at the upper limit of normal, and his CK index was normal.

After doing some research I discovered that sepsis, septic shock, systemic inflammatory response syndrome (SIRS),  hypotension, and hypovolemia, renal failure, inflammatory disease, burns > 25 % BSA, exertion, and post transplant were a few of the many reasons that could cause a "non cardiac event"  elevation in one's troponin.

I will let you research the patho behind these causes if you feel the need, but the point of this lesson is:
Sometimes we, as providers, forget that every patient does not "read the book". We ALWAYS have to treat the patient, not the monitor, or the lab results. If something isn't making sense, we probably need to look at it from a different direction.

In my patient, I ultimately found he had a chronic (undiagnosed) GI bleed. If I had "knee jerked" and given aspirin for an elevated troponin (thank you Dr Bandura, who told me "if the index is normal, look for something else"), I would have potentially made the patient worse.

Have a GREAT day!