Raised cardiac troponins

Causes extend beyond acute coronary syndromes

Cardiac troponins are regulatory proteins of the thin actin filaments of the cardiac muscle. Troponin T and troponin I are highly sensitive and specific markers of myocardial injury. Serial measurement of troponin I or troponin T has become an important tool for risk stratification of patients presenting with acute coronary syndromes. The joint committee of the European Society of Cardiology, the American College of Cardiology, and the American Heart Association has recently accepted their measurement in serum as the standard biomarker for the diagnosis of acute myocardial infarction and for diagnosis and management of acute coronary syndromes.1 2 Cardiac troponins, however, are raised in many patients presenting with conditions other than acute coronary syndromes (box). To ignore this fact will lead to unjustified, potentially harmful investigations and increases medical costs. In sepsis, for example, cardiac troponins are raised in up to 85% of patients in the absence of any acute coronary syndromes.3 Doctors need to be aware that troponins are biochemical markers that replace neither electrocardiograms nor clinical investigation.

In the …