This is the last update in 2012, but I am happy to end this year with one of the most challenging topics in medicine. The article is from J Am Coll Cardiol in Dec. You can find the Full text link here
1. Remeber: Troponin elevation imparts a worse prognosis, irrespective of the underlying etiology.
2. Elevated troponin is a sensitive and specific indication of cardiac myonecrosis, with troponin release from myocytes into the systemic circulation, but Troponin elevation occurs in many nonischemic clinical conditions such as:
b. right ventricular (RV) pressure overload following a PE
c. heart failure
f. thermal injury
g. blunt cardiac trauma
and you know about endocarditis, chronic lung diseases and …
3. we discussed this before: the role of CAD (MI) and ESRD and Troponin, but again: Dynamic changes in troponin values of ≥20% over 6 to 9 h should be used to define acute MI in ESRD patients.
Very , Very Very Important:
4. “In the large, multicenter ADHERE (Acute Decompensated Heart Failure Registry) National database, 81% of patients admitted with heart failure had troponin testing, and nearly 6.2% of patients had abnormal troponin test results (troponin I ≥1.0 μg/l or troponin T ≥0.1 μg/l) after excluding patients with serum creatinine >2.0 mg/dl . Hospital mortality among troponin-positive patients was 8.0%, compared with 2.7% among troponin-negative patients (adjusted odds ratio [OR]: 2.55) and was independent of an etiology of heart failure (ischemic or nonischemic)”.
Our job is not to risk stratify Patient with Heart Failue in ED with high troponin