Perhaps you’ve heard the word “troponin” when in the emergency room, either in reference to yourself or a family member.
You may have seen a nurse draw blood for “troponins” or “tropes.”
Troponin is a very important protein that exists in muscles.
Its main job is helping those muscles tighten and relax. Without troponin, your muscles wouldn’t move the way they should.
There are a few types of troponin in the body. Some are found in skeletal muscles, like the muscles in your arms and legs.
One specific type is found only in the heart. That heart-specific form is the one doctors really pay attention to.
Troponin and the Heart
Inside your heart cells, troponin helps the heart squeeze blood out and pull blood in during each beat.
It’s like a helper that keeps the rhythm going. Under normal circumstances, troponin stays inside the heart muscle cells where it belongs.
Only tiny traces float around in the bloodstream on a normal day.
They’re usually so low that blood tests barely detect them, if at all.
Why Doctors Check Troponin Levels
Doctors measure troponin to see if the heart has been damaged.
If heart cells get injured, even slightly, troponin leaks into the bloodstream.
When the level goes up, it can be a sign that the heart is under stress or not getting enough oxygen.
A blood test is all it takes to check troponin. Just a simple blood draw, then the lab measures how much troponin is present.
This test can come back within minutes to an hour when an ER nurse uses advanced testing that’s highly sensitive.
For standard hospital labs, the result may take one to two hours.
In the past, patients had to wait four hours to find out if their troponin level was abnormal.
When Troponin Levels Rise
A high troponin level can mean that there’s an injury to the heart muscle. One cause is a heart attack.
Anyone who comes into the ER reporting chest pain will get a “trope” test.
This protein-enzyme takes its sweet time leaking into the bloodstream following a heart attack.
Thus, the first troponin test may show a negative result. This is why the patient will be urged to remain in the ER setting for another several hours for a second blood draw.
It can take hours after a heart attack for enough troponin to be detected, even though the test is extremely sensitive.
If the result is positive for elevation, this will be very concerning.
If your result was negative for that first draw — you absolutely need to stay in the ER for a follow-up draw.
A follow-up draw that’s negative is very reassuring in that it rules out a heart attack at that time.
But the chest pain or shortness of breath (another symptom that will net a troponin test) that brought the person there in the first place could very well be coming from coronary artery disease — serious enough that a heart attack is imminent.
My mother’s first ER visit resulted in two negative troponin values.
Not long after, her second visit netted a value in an “indeterminate” range or “grey area,” as we were told. She was admitted for a more in-depth cardiac workup.
She ultimately needed quintuple bypass surgery!
Depending on the patient’s age and medical history, they’ll be told to follow up with a cardiologist if their troponin results are normal for both tests.
In some cases, three draws are taken, depending on the value of the first draw.
Doctors want to see if there’s an upward trend of the resulting number; an upward trend is very worrisome.
But it’s important to know that elevated troponin doesn’t always mean a heart attack.
So in my mother’s case, it wasn’t a heart attack — but her heart was in danger.
A healthy person should not have an elevated troponin result that continues to rise with subsequent tests.
Why Troponin Can Increase
The following factors can cause a slightly elevated troponin number:
1 Very intense exercise
2 An infection
3 Inflammation of the heart
4 Kidney disease
5 Extreme mental stress
Sometimes levels rise for short periods and then return to normal.
That’s why doctors don’t rely on the test alone.
They look at symptoms, EKG results, medical history and repeat blood tests over several hours.
They watch whether troponin levels rise, fall or stay the same.
If they go down, it might mean the heart is recovering from something minor.
