A person who’s diagnosed with a heart attack in the ER based on an elevated troponin result may not have had a heart attack after all.
The European Heart Journal has a 2018 study (Thygesen et al) that says “many doctors have not understood that elevated troponin levels in the blood are not sufficient to diagnose a heart attack.”
The paper explains that a heart attack causes injury to cardiac muscle. The protein troponin is used for cardiac muscle contraction.
But it’s released into the bloodstream upon injury to that specialized muscle.
A highly sensitive blood test will tell if there’s even the must subtle rise in troponin.
The reason that an abnormal level of troponin doesn’t always mean a heart attack is because there are other situations that injure cardiac muscle.
Does elevated troponin automatically mean the patient has had a heart attack?
“Not always, but the most common reason to order a troponin level is usually to rule out a heart attack,” says Christopher J. Hanifin, PA-C, who was previously a physician assistant in open heart surgery with Cardiothoracic Surgery of South Bend in South Bend, IN.
“Anything that severely stresses or damages the heart can cause an elevation of troponin, though not usually to the extent seen in a heart attack.
“Heart failure, trauma, pulmonary embolism and even kidney failure can lead to elevated troponin levels.” So can a body-wide infection (sepsis).
Correct identification for the reason of a rising troponin level is crucial because even different types of ischemia to the heart have different causes. Different causes mean different treatments.
One type might require antiplatelet drugs, while another treatment (for a different cause) may require beta blocker drugs.
In some cases, the cause of an elevated troponin result is not known, though the cause may be strongly suspected, such as chronic heart failure in an elderly patient.
Christopher J. Hanifin, PA-C, is currently Department Chair and Assistant Professor, Department of Physician Assistant, Seton Hall University, NJ.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.