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.

#cardiology

Reference:

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