Highest Troponin Levels You've Seen?

Specialties CCU

Updated:   Published

Hello Everyone,

First, a caveat. I'm in my last semester of school doing a precepted clinical in CCU, so basically, I know absolutely nothing about anything. Please forgive my ignorance. If you would indulge me, I'd appreciate it.

Just curious -- what is the highest troponin level you've ever seen? I had a patient last week admitted through ER with an initial troponin of .21, chest pain, a slightly depressed ST segment (ECG normal otherwise), and a dx of r/o MI. During the night, his next two troponins came back at 78 and 144. He came to the unit on nitro and heparin drips and received an MS IV push twice for mild chest pain. We kept him NPO, the doc was, of course, notified (when each lab was received), and pt sent to the cath lab in am. He is now post-CABG and doing well. But 144?!! It seems pretty high to me, and my preceptor had never seen a number that high, either.

I had a pt in the peri-arrest situation with a troponin that came back as >50000 (which is as high as it will read, it was initially 13 post-STEMI). I think from reading these that is also the equivalent to >500 elsewhere. Did well on inotropes.

Working in Canada, I've seen 54 for troponin.

St elevation MI.

Usually, I see around 10-20 on most pts. Only been working for two years, so hopefully, the number will go down.

Specializes in Neurosciences, cardiac, critical care.
jelly221,RN said:
Oh God, I was terrified reading these posts until I realized my hospital uses a different scale. I had a 3.4 (on our scale) the other day, so 3,400 by the standards here. Huge sub endo, MI silly goose went and pulled his A-line out after the stent placement before we could do it and STILL went home the next day. Lucky!

Just wanna clarify/correct - my hospital uses ng/mL, in which

I've just checked my notes discharge notes for my initial troponin level. Following admission to the hospital and a blood test after 6 hrs following the suspected heart attack, the blood came back with a Troponin level of 2041, yes 2041; I believe there are a number of methods to measure the levels so that it may be out of sync with yours but needless to say, it's very high.

On a positive note 6 days later, troponin was down to 70, and the consultant's write-up was similar to this,

No coronary disease or narrowing of coronary arteries other than L.A.D slightly narrowed around 20%, minor damage to heart and recurrence unlikely.

This followed a two-week stay in the hospital, numerous tests and checks, not to mention monitoring, angiogram, MRI scan etc etc.

The reassurance, I would say, is the order of the day, and whatever the level of troponin, the outlook can still be good.

Thanks to all who got me through a testing time and made my stay so bearable; you all do great work; thanks again.

300 was the highest I've seen. Wow, someone on here saw a patient with 580!

My personal high was 1376, but it dropped today to somewhere around 1000. My main complaint was that my chest was hurting (9 on a scale from 1 to 10). Just after I threw up, they tested my blood because they didn't believe the first value (1100 or so). It is a problem with my heart muscle caused by a virus in my heartsick or so.

Impella, Swan, CRRT, four pressors, etc. Oh, the joys.

Specializes in CVICU, CCRN.

My new admission, admitting diagnosis, was chest pain. After doing admitting questions, he told me he was starting to have chest pain 6/10. Gave x2 sublingual nitro. No relief. Lab called me about five minutes later, reporting a 500-troponin. I worked nights and tried calling the house doctor -- no answer. I called RRT -- sent pt to ICU.

I just recently went through the AACN ECCO program through my hospital; something that took me off guard was (either the program or my instructor) saying that it was unnecessary to let a provider know if a Troponin is elevated if the previous was one also elevated, regardless of whether or not it was trending up. The rationale was that the only diagnostic value was whether or not it was positive, not whether it was trending.

Now, this is not taking into consideration other clinical signs or symptoms (c/o chest pain, hypotension, EKG changes, etc.)

I was wondering about anyone else's take on that.

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