Sometimes we request a troponin level for patients without a presenting symptoms suggestive of ischemia.
This opens the door also for a discussion about type II MI which we usually find it due to the previous scenario.
So when to ask for troponin level and what is the significance of type II myocardial infection?
If the heart muscle may be damaged, Troponin T and Troponin I will be assessed, in addition to a 12-channel ECG. Other endogenous substances that are elevated after a heart attack and need to be determined include various proteins (myoglobin, creatine kinase, lactate dehydrogenase, glutamate-oxaloacetate transaminase). As these parameters occur in other cells as well they are not specific for heart lesions. Meanwhile there are even more sensitive tests available. Troponin T hs (hs, highly sensitive) can indicate an acute myocardial infarction earlier than previously.
Troponin is an exquisitely sensitive marker of myocardial necrosis, and is necessary for establishing the diagnosis of MI in a clinical setting consistent with ischemia. Myocardial infarctions are classified by the etiology of the ischemia, which influences subsequent management strategies. Elevated troponin levels in the absence of ACS should prompt an evaluation for a non-thrombotic mechanism of troponin increase.
Ref: 1. Article The utility of troponin measurement to detect myocardial inf...
2. https://www.acc.org/latest-in-cardiology/articles/2018/07/16/09/17/high-sensitivity-cardiac-troponin-in-the-evaluation-of-possible-ami
Troponin is a very useful clinical marker to diagnose Acute myocardial infarction. However, it becomes positive in a number of non cardiac conditions. A positive result is only significant in the presence of an appropriate clinical history. A troponin should only be requested when a patient is suspected to have an acute myocardial infarction (MI).
Positive result without acute coronary event leads to unnecessary workup, prolonged hospital stay
Elevated troponin is not specific for ACS alone. It can occur in acute ischaemic stroke, sepsis, kidney failure or CKD, heart failure, and pulmonary embolism. Attached are 2 references on troponin levels:
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