Cardiac
troponins are the most sensitive and specific markers of myocardial injury. In fact, the Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of
myocardial infarction (MI) states that
troponins are the preferred cardiac marker for detecting myocardial injury. For the aforementioned reasons,
troponin levels are routinely ordered for patients presenting to the emergency department with
chest pain,
dyspnea,
syncope, or any other possible presentations of MI. While
troponin levels do reflect the extent of myocardial damage, they do not necessarily indicate
myocardial ischemia in a subset of patients. Elevated
troponin levels can be due to a wide array of mechanisms in the absence of
myocardial ischemia and injury. Thus, relying solely on
troponin levels, in the presence of a normal electrocardiogram (ECG), to diagnose
myocardial ischemia can lead to unnecessary and expensive invasive testing. It is therefore important for the clinician to keep in mind the varying causes of
troponin elevations in order to provide the highest value care to the patient. We present a case and review of literature regarding patients who present with elevated
troponin levels in the absence of any
coronary artery disease.