Have you ever received sign-out on a patient, heparinized, awaiting cardiology consultation – and later, at your leisure, realized the troponin level just barely tips into positive territory and probably has nothing to do with acute coronary syndrome?
I know you have.
This is the cardiology "expert consensus" on interpretation of troponin elevations – 25 pages of clinical summary and 360 references worth of dissecting what an elevated troponin really means. There's an hour-long lecture worth giving based on this publication.
The key portions include:
- Figure 1, which is a nice conceptual overview in which elevated troponins are separated into their "ACS" and "non-ACS" categories.
- Section 6, which discusses the possible role (if any) for troponins in non-ischemic conditions.
- Appendix 4, the clinical conditions in which positive troponins are non-cardiac and confounding in origin.
Positive troponins need to be evaluated properly in their clinical context, and this is a lovely (if very, very long) reference document for describing it.
"ACCF 2012 Expert Consensus Document
on Practical Clinical Considerations in the
Interpretation of Troponin Elevations"