Our assay sensitivity for troponin has significantly increased, which lowers its specificity. While measurement of troponin levels are a very routine test in acute presentations, a good differential beyond acute coronary syndrome is necessary.
- Cardiac contusion
- Ablation, pacing.
- Congestive heart failure (acute or chronic).
- Aortic dissection
- Aortic valve disease
- Hypertrophic cardiomyopathy
- Tachyarrythmias, bradyarryhtmias, or heart block
- Apical ballooning syndrome
- Rhabdomyolysis with cardiac injury
- Pulmonary embolism
- Severe pulmonary hypertension
- Renal Failure
- Acute neurological disease (including stroke, SAH)
- Infiltrative disease (amyloidosis, hemochromatosis, sarcodoisis, or scleroderma0.
- Inflammatory diseases (myocarditis, pericarditis, myocardial extension of endocarditis)
- Drug toxicity or toxins
- Critically ill patients, especially with respiratory failure or sepsis
- Burns, especially if >30% TBSA
- Extreme exertion
