Troponin levels

Specialties Cardiac

Published

Regarding troponin levels...

Does the higher the troponin level = more cardiac damage and poorer prognois? Or after a certain level, it's all considered extensive damage?

I'm a fairly new nurse, and I don't work on a cardiac floor. So most of my patients get cardiac enzymes to rule out MI's. Mostly they come back negative or slightly elevated. Reason I'm asking is that someone in my family with CHF and loads of cardiac and other health issues just had an MI while in the hospital for CHF exacerbation, and the troponin level was 40. that's quite elevated--but I haven't seen enough elevated troponin levels to know if that's wildly elevated, or a value that's seen often enough with MI's....

I'd appreciate any info, I've tried to research it in my books and on the internet, but I can't get any specific info.

Specializes in Emergency.

It also depends on which troponin is being measured. Is it troponinT or troponinI. I did critical care transport for little over a year. We did followup visits to the floor on most of our pts- we were bringing them back to our own hospital. I can recall seeing one level in the 1280 range. The level does coordinate with the size of the MI to some extent but it also can coordinate on how effective reprefusion is. I have seen some pretty big spikes after PTCA/stenting for example, ie the enzyme cant make it to the blood stream if there is no flow to the tissue. So one potentally can have a huge MI but yet have relatively low troponin levels, as can the opposite a small MI with a early successful angioplasty and have high levels.

Rj:rolleyes:

:yeah:

That's why I love this job. We literally bring people back from the dead. It's just so amazing to work this unit, isn't it?

The last person my hospital stented, coded and died :(

Specializes in Utilization Management.
The last person my hospital stented, coded and died :(

And what would've happened to that patient if no stent was placed?

Specializes in tele, stepdown/PCU, med/surg.

Also beware of false-high troponins often caused by sepsis, "leaking" troponin, or even coumadin usage (the blood has to clot to accurately measure troponins; may not clot completely if on anticoags)

Hey Y'all

Got to looking in to this (troponin I & troponin T--who knew?) Ran across a Jama article where they routinely checked troponin on 209 NON-CARDIAC pts in ICUs. 32 of these had +troponin. Of the 32, 12 were recognized by the ICU staff as having MIs but 20 had 'silent' MIs while in the ICU. Again-of the 32 there wasn't significant difference in mortality between the group that was recognized and the silent-mi group (40% diagnosed, 42% silent). The unrecognized mi's were more likely to be either young or black.

jama.ama-assn.org/cgt/content/abstract/273/24/1945

Also--at least some time in recent past, the Troponin T was only detectable by one manufacturers machines but several companies made lab equipt that found Troponin I.

for what it's worth

Papaw John

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