Troponinemia

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Check out this article by Louisville cardiologist John Mandrola. It is worth reading in full, just one and a half pages. Mandrola and coauthor Foy comment on an iatrogenic coronary dissection during a cath performed for a + troponin in SVT. Check out Table 1, very nice for conceptualizing Troponin elevation.

The TL;DR: carefully interpret troponin elevation when you do not suspect a type 1, acute coronary occlusion MI. As I always tell you guys, a very important binary to collapse in ED patients is, does this patient have an acute occlusion, or OMI.

If you are ordering a troponin in a patient with tachycardia from fever, SVT, afib, or even bradycardia, be prepared for an elevation. But unlike STEMI or STEMI equivalents (ie OMI), this troponin elevation may not require any specific treatment, especially cardiac cath. Treat the underlying condition, even if using troponin as a prognostic marker. This applies more for cardiologists, but we have a role as well. For instance, Amal Mattu says to not even obtain Trop in young healthy SVT patients (I agree).

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