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)