"Troponitis": Non ACS causes of increased troponin

Elevation of troponins in the absence of an acute coronary syndrome (ACS) are a commonly encountered issue in ER consultations to GIM.  The two key issues always are:  make sure you exclude an actual ACS and look for an alternative explanation (see long list below).  Simply calling it troponitis relegates it to the background, potentially leading to gaps in care.

To ensure you are not missing an ACS: consider the patients clinical picture and carefully assess the ECG for signs of ischemia. Also repeat the troponin measurement as the trend and magnitude of increase (see figure) relate to the likely etiology.  Very high troponins are indicative of severe myocardial damage from a large MI or myocarditis.
 

Reasons for acutely elevated troponins: Acute coronary syndrome; Acute heart failure; Pulmonary embolism; Stroke; Acute aortic dissection; Tachyarrhythmias; Hypotension /Shock; Sepsis; ARDS; Perimyocarditis; Endocarditis; Tako-tsubo cardiomyopathy; Radiofrequency catheter ablation; Cardiac contusion; Strenuous exercise; Sympathomimetic drugs; Chemotherapy

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