Troponin levels Troponin levels | allnurses

Troponin levels

  1. 0 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.
  2. 16 Comments so far...

  3. Visit  MandyInMS profile page
    0
    Was the result 40 or 4.0 ?? I'm not a cardiac nurse ,but in our facility anything > 0.1 is considered elevated. Either way that's HIGH.
  4. Visit  mysterybe profile page
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    His nurse had said 40... I never have seen a level that high. Perhaps she had mispoke...but I definitely heard 40. I guess that's why I'm posting this...'cause I've not seen one that high before and wondering if that's possible.
  5. Visit  talaxandra profile page
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    I just asked our clinical co-ordinator - the higher the level the greater the degree of infarction. Regarding outcome: it depends on where the damage is, what kind of collateral circulation the patient has, general condition, type and speed of treatment etc.
    I haven't seen many levels over the mid-40 mark, but she said that some patients have come in with troponin levels over 500 (on the off-chance that there's a difference in US/Australian unts of measure, significant is >0.3).
    I hope this helps
  6. Visit  pricklypear profile page
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    A level of 40 would signify a significant MI or other cardiac event. I've seen tropis over 300 a few times. These were after MIs with multiple vessels involved = multiple areas of damage.
  7. Visit  UM Review RN profile page
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    I've never seen a trop in the hundreds--hard to imagine what their quality of life would be after an event like that --but in the 40s, yes.

    I consider that pretty high.
  8. Visit  mysterybe profile page
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    Thank you for your replies. I didn't know levels could get in the hundreds! It would make sense the higher the value = more damage. I appreciate your time and information.
  9. Visit  pricklypear profile page
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    Quote from Angie O'Plasty, RN
    I've never seen a trop in the hundreds--hard to imagine what their quality of life would be after an event like that --but in the 40s, yes.

    I consider that pretty high.
    Actually, these people survived after immediate intervention with multiple stents and, in some cases, IABP for a few days.
  10. Visit  UM Review RN profile page
    0
    Actually, these people survived after immediate intervention with multiple stents and, in some cases, IABP for a few days.



    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?
  11. Visit  pricklypear profile page
    0
    Quote from Angie O'Plasty, RN


    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?
    I agree, it is awesome!!
  12. Visit  mommatrauma profile page
    0
  13. Visit  SEOBowhntr profile page
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    The correct answer is "YES." But having said that, depending on a patient's pre-incident Cardiac Function, a patient who has a large MI with Troponin Pk @ 500 will have a varying level of recovery. I've seen many Troponins >500, and they are measured the same in UK, Austalia, and USA. Actually a pt. with a Trop. Pk around 40, has probably had a small MI, and should have a good prognosis.

    Good facilities will have a "Door to Balloon" time of 30-60minutes, meaning the patient coming in presenting with an acute MI will be in the cath lab within that period of time, and a balloon will be introduced to the blockage causing the ischemia.

    However, as mentioned in the article, CK and CK-MB's are a better indicator of an acute change, not Troponin.

    Doug
  14. Visit  rjflyn profile page
    0
    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

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