DOI: https://doi.org/10.22141/2224-0586.16.1.2020.196928

Cardiac troponins in clinical practice

S.M. Stadnik

Abstract


The aim of our literature review was to describe causes and mechanisms which underlie increased cardiac troponin levels in patients without established myocardial infarction. The widespread introduction of high-sensitivity analyses for troponin determination into everyday practice, which became highest in European countries, has led to a significant acceleration of therapeutic and diagnostic process and improved prognosis for patients. However, there is a downside of high-sensitivity methods: the higher the troponin detection capability, the lower the specificity, which can complicate and/or lead to differential diagnosis errors, especially if clinicians rely on laboratory data alone. An important direction for improving differential diagnosis is to establish accurate mechanisms for increasing the level of troponins in order to evaluate the comparative kinetics of concentration, which should certainly be taken into account for the improvement of rapid algorithms for the diagnosis of acute coronary syndrome. The review deals with the clinical and diagnostic value and mechanisms of an increase in the level of cardiac troponins in conditions not associated with acute coronary syndrome: strokes, aortic dissection, inflammatory myocardial diseases, pulmonary embolism, arterial hypotension, heart fai­lure, takotsubo syndrome, closed chest injury, acute respiratory distress syndrome, chronic renal failure, sepsis, rhabdomyolysis, bleeding from the upper gastrointestinal tract, surgical interventions, physical activity.

Keywords


troponins; myocardial infarction; non-coronary causes of elevated troponins; stroke; aortic dissection; pulmonary embolism; chronic renal failure; sepsis; physical activity; review

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