Elevated troponin is non specific ...troponin elevation doesn't mean always AMI...
There are myriad causes for elevated troponin ...
Chronic elevation like in HF patient or renal failure
Acute elevation could be due type 2 MI which essentially a demand supply phenomenon..fix the cause first ,and look If the patient needs further testing
The most important cause of elevated troponin is AMI type 1 ....here you got to activate ACS algorithms ...
In practical approach ,what to do with a raised troponin:
(a) Repeat the troponin level and assess for a rise and/or fall.
(b) If there is no rise and/or fall, this is not AMI. Think about the patient: is this someone you expect to have a chronic troponin elevation or is this totally unexpected?
(c) If the troponin is elevated and there is a rise and/or fall on serial testing, think about the clinical context. Is there an underlying condition causing a supply-demand imbalance? If so, this is most likely a type 2 AMI. Treat the underlying condition first, then consider whether you need to investigate for underlying coronary artery disease.
(d) If the history is compatible with an acute coronary syndrome, there is no supply-demand imbalance and the troponin is elevated with a rise and/or fall, then this is most likely to be a type 1 AMI. These patients benefit from all the proven treatments for acute coronary syndrome.
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