ACS related
Acute MI (STEMI & NSTEMI)
Post‐PCI
Open heart surgery / Any cardiac surgery
Non‐ACS related
Tachycardia: SVT, V-Tach, A-Fib with RVR or any tachycardia.
Atrial Fibrillation
Pericarditis, Myocarditis, Endocarditis
Massive or submassive Pulmonary Embolism
Sepsis
Hypotension
Critical illness (Medical ICU patients)
Viral illness
Hypertension
Thrombotic thrombocytopenic purpura
CVA (Stroke): Hemorrhagic stroke (Subarachnoid hemorrhage); Ischemic stroke
Head trauma
Asymptomatic patients with ESRD
Chronic kidney disease
Acute Aortic dissection
Acute Heart Failure
Chronic Heart Failure
Apical ballooning syndrome
Strenuous exercise/ultra‐endurance exercise
Cardiotoxic chemotherapy
Hypersensitivity drug reactions
High-frequency ablation/ current cardioversion‐defibrillator shocks
Cardiac infiltrative disorders: Amyloidosis, sarcoidosis, hemochromatosis, scleroderma
Left ventricular hypertrophy
Infiltrative disease
Heart transplant
Cardiac contusion after blunt chest wall trauma / Direct myocardial trauma
ARDS
COPD exacerbation
Severe GI bleeding
Rhabdomyolysis
Severe skin burns
Kawasaki disease
Neurofibromatosis
Duchenne muscular dystrophy
Klippel-Feil syndrome
Environmental exposure: Carbon monoxide, hydrogen sulfide
Diabetes
Hypothyroidism
Envenomation
False-positive troponin elevation
Understanding the Differential Diagnosis
“Supraventricular or ventricular tachycardia, atrial fibrillation with a rapid ventricular response, or any other tachycardia may cause troponin elevation by increasing the myocardial oxygen demand without epicardial coronary stenosis.”
“Studies of intensive-care-unit patients report that troponin is elevated in patients with increased myocardial demand due to multiple comorbid conditions, positive end expiration therapy, the need for inotropic support, or high body temperature; these patients typically have higher morbidity and mortality rates”
References and Further Study
Korff S, Katus HA, Giannitsis E. Differential diagnosis of elevated troponins. Heart. 2006;92(7):987-993. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860726/
Tanindi A, Cemri M. Troponin elevation in conditions other than acute coronary syndromes. Vascular Health and Risk Management. 2011;7:597-603. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3212425/
http://www.acc.org/latest-in-cardiology/articles/2014/07/18/13/16/causes-of-non-acs-related-troponin-elevations