Tuesday, November 6, 2018

elevated troponin levels but a normal coronary angiogram

Q; Which of the following is found to be the most common cause of elevated troponin levels but a normal coronary angiogram?

A) Tachycardia 
B) Pericarditis 
C) Heart failure 
D) Strenuous exercise 
E) No clear reason

Answer: E

Although elevation of troponin seems to be very specific for cardiac ischemia, there is still a huge laundry list of non-cardiac causes of elevated troponin. Few very important ones and clinically relevant ones are

  • Sepsis 
  • Acute neurological events, including subarachnoid hemorrhage 
  • Pulmonary embolism 
  • Severe pulmonary hypertension 
  • Aortic dissection 
  • Hemochromatosis 
  • Scleroderma 
  • Snake venom 
  • More than 25% of body surface area burns
Interestingly, in one albeit small study, nearly half of the patients were found to have no clear-cut reason for elevated troponin. It is assumed that some sort of myocardium damage occurs due to increase demand.



Bakshi TK, Choo MK, Edwards CC, et al. Causes of elevated troponin I with a normal coronary angiogram. Intern Med J 2002; 32:520.

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