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Troponin

Aka: Troponin, Troponin Assay, Increased Troponin Causes, Causes of Abnormal Troponin

I. See Also

  1. Serum Cardiac Markers
  2. Troponin T
  3. Troponin I
  4. Ultrasensitive Troponin T (hs-cTnT)
  5. Acute Coronary Syndrome

II. Physiology: Dynamics

  1. Rises: 2-4 hours (but may be delayed to 8-12 hours in minor injury)
  2. Peaks: 12-24 hours
  3. Duration: 14 days (in large Myocardial Infarction)

III. Physiology: Subunits

  1. Troponin T
  2. Troponin I
  3. Ultrasensitive Troponin T (hs-cTnT)

IV. Causes: Increased Troponin

  1. Acute Coronary Syndrome (Myocardial Infarction)
  2. Arrhythmia
    1. Atrial Fibrillation with rapid ventricular rate
    2. Supraventricular Tachycardia (15-20% of cases)
  3. Cardiac injury, stress or increased myocardial oxygen demand
    1. Cardiac procedures
    2. Chronic Severe Hypertension
    3. Severe Cardiomyopathy (including Hypertrophic Cardiomyopathy)
    4. Congestive Heart Failure
    5. Myocarditis
    6. Pericarditis
    7. Marathon Running or other strenuous Exercise
    8. Cardiac Contusion
    9. Endocarditis
    10. Arrhythmia (e.g. PSVT, Atrial Fibrillation with RVR)
  4. Non-cardiac conditions
    1. Chronic Renal Failure
    2. Hypoxia
    3. Pulmonary Embolism
    4. Pulmonary Hypertension
    5. Chemotherapy
    6. Cerebrovascular Accident
    7. Subarachnoid Hemorrhage
    8. Aortic Dissection
    9. Burn Injury
    10. Acute Respiratory Distress Syndrome (ARDS)
    11. Sepsis
    12. Severe Anemia
    13. Shock
  5. References
    1. Agewall (2011) Eur Heart J 32(4): 404-11 [PubMed]

V. Approach: Precautions

  1. Obtain Troponin for risk stratification when pretest probability of Acute Coronary Syndrome is high
    1. Ultrasensitive Troponin T has a high False Positive Rate
    2. Positive Troponin In low probability Chest Pain will subject that patient to unnecessary stress testing (in some cases angiogram)
  2. Interpret Troponin In context of history, exam and Electrocardiogram
    1. A normal Troponin does not exclude Acute Coronary Syndrome in the context of a concerning history or clinical findings
    2. An abnormal Troponin In the absence of other clinical findings is not equivalent to Acute Coronary Syndrome
  3. Compare Troponin level to prior Troponin levels and establish a baseline
    1. Mild chronically elevated Troponin Is common in Chronic Kidney Disease and Congestive Heart Failure
    2. Obtain a second Troponin In 4-6 hours to establish a trend in mildly elevated Troponin levels despite other reassuring findings
  4. Troponin Increase suggests myocardial cell injury (outside of Chronic Kidney Disease)
    1. First exclude Acute Coronary Syndrome
    2. Next optimize management of conditions with increased myocardial oxygen demand (e.g. CHF, Sepsis)
    3. Finally, consider Troponin Increase a potential marker for worse prognosis in acute presentations (e.g. CVA)

VI. References

  1. Mattu in Majoewsky (2013) EM:Rap 13(9): 5
  2. Ebell (2000) J Fam Pract 49:550-6 [PubMed]
  3. Newby (2012) J Am Coll Cardiol 60(23):2427-63 [PubMed]

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Ontology: Troponin (C0041199)

Definition (CHV) a protein found in muscle that helps it contract
Definition (CHV) a protein found in muscle that helps it contract
Definition (MSH) One of the minor protein components of skeletal muscle. Its function is to serve as the calcium-binding component in the troponin-tropomyosin B-actin-myosin complex by conferring calcium sensitivity to the cross-linked actin and myosin filaments.
Definition (CSP) complex (T,I,C) which mediates actin-myosin contractile phenomena; troponin C, when saturated with calcium, permits myosin to displace tropomyosin from actin filaments.
Concepts Biologically Active Substance (T123) , Amino Acid, Peptide, or Protein (T116)
MSH D014336
SnomedCT 102680009
Swedish Troponin
Czech troponin
Finnish Troponiini
Russian TROPONIN, ТРОПО�И�
English Troponin complex, Troponin [Chemical/Ingredient], troponins, troponin, Troponin, Troponin (substance), Troponin, NOS
Polish Troponina
Croatian Not Translated[Troponin]
Spanish troponina (sustancia), troponina, Troponina
French Troponine
German Troponin
Italian Troponina
Portuguese Troponina
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Troponin measurement (C0523952)

Definition (NCI_CDISC) A measurement of the total troponin in a biological specimen.
Definition (NCI) The determination of the amount of total troponin present in a sample.
Concepts Laboratory Procedure (T059)
SnomedCT 105000003
CPT 84484
Italian Troponina, Troponina NAS
Dutch troponine NAO, troponine
French Troponine SAI, Troponine
German Troponin NNB, Troponin
Portuguese Troponina NE, Troponina
Spanish Troponina NEOM, medición de troponina (procedimiento), medición de troponina, Troponina
Japanese トロ�ニン, トロ�ニンＮＯＳ, ﾄﾛﾎﾟﾆ�NOS, ﾄﾛﾎﾟﾆ�
Czech Troponin, Troponin NOS
English serum troponin measurement (lab test), serum troponin measurement, serum troponin, troponin level test, Troponin NOS, Measurement of troponin, Troponin Measurement, TROPONIN, Troponin, Troponin measurement (procedure), Troponin measurement, Troponin measurement, NOS, troponin test, Test;troponin
Hungarian Troponin, Troponin k.m.n.
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pathology and Laboratory Medicine

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