{"id":397,"date":"2013-01-03T20:48:26","date_gmt":"2013-01-04T01:48:26","guid":{"rendered":"http:\/\/emeddoc.org\/?p=397"},"modified":"2013-01-03T20:48:56","modified_gmt":"2013-01-04T01:48:56","slug":"challenges-regarding-troponin","status":"publish","type":"post","link":"https:\/\/emeddoc.org\/?p=397","title":{"rendered":"Challenges regarding Troponin"},"content":{"rendered":"<p>This is the last update<strong> <\/strong>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 <a href=\"http:\/\/content.onlinejacc.org\/article.aspx?articleid=1389700\">here<\/a><br \/>\n1. <strong>Remeber: <\/strong>Troponin elevation imparts a worse prognosis, irrespective of the underlying etiology.<!--more--><\/p>\n<p>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:<\/p>\n<div>a. Hypoxemia<br \/>\nb. right ventricular (RV) pressure overload following a PE<br \/>\nc. heart failure<br \/>\nd. CKD,<br \/>\ne. sepsis<br \/>\nf. thermal injury<br \/>\ng. blunt cardiac trauma<br \/>\nh. SAH<br \/>\nand you know about endocarditis, chronic lung diseases and &#8230;&nbsp;<\/p>\n<\/div>\n<p>3. <span>we<\/span> discussed this before: the role of CAD (MI) and ESRD and Troponin, but  again: Dynamic changes in troponin values of \u226520% over 6 to 9 h should  be used to define acute MI in ESRD patients.<br \/>\n<strong><br \/>\nVery , Very Very Important:<\/strong><\/p>\n<p>4. &#8220;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 \u22651.0 \u03bcg\/l or troponin T \u22650.1 \u03bcg\/l) after  excluding patients with serum creatinine &gt;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)&#8221;.<br \/>\n<strong> <\/strong><\/p>\n<p><strong>Our job is not to risk stratify <\/strong><strong><strong>Patient\u00a0 with <\/strong>Heart Failue in ED with high troponin<\/strong><\/p>\n<p>&nbsp;<\/p>\n<p><strong><a href=\"http:\/\/content.onlinejacc.org\/article.aspx?articleid=1389700\">Link To Full Text<\/a><br \/>\n<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>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.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[21,13,14,15,16],"tags":[],"class_list":["post-397","post","type-post","status-publish","format-standard","hentry","category-cardiology","category-pgy1","category-pgy2","category-pgy3","category-pgy4"],"_links":{"self":[{"href":"https:\/\/emeddoc.org\/index.php?rest_route=\/wp\/v2\/posts\/397","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/emeddoc.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/emeddoc.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/emeddoc.org\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/emeddoc.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=397"}],"version-history":[{"count":3,"href":"https:\/\/emeddoc.org\/index.php?rest_route=\/wp\/v2\/posts\/397\/revisions"}],"predecessor-version":[{"id":400,"href":"https:\/\/emeddoc.org\/index.php?rest_route=\/wp\/v2\/posts\/397\/revisions\/400"}],"wp:attachment":[{"href":"https:\/\/emeddoc.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=397"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/emeddoc.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=397"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/emeddoc.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=397"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}