Raised Troponin
at the bedside
- ECG now, compare with the old one; repeat with any symptom change
- check vitals; ischemic symptoms? chest pain, dyspnea, sweating, syncope
- troponin = myocardial injury, not always infarction
escalate now if
- ongoing ischemic chest pain → ACS
- dynamic ECG changes (ST shift, new LBBB) or rising troponin → ACS, cardiology now
- hemodynamic instability or arrhythmia → hypotension, palpitations
- new heart failure → dyspnea; rise without ischemia → type 2 or injury
- cardiac arrest
focused check
- ACS → chest pain or equivalent + dynamic ECG
- supply-demand → tachyarrhythmia, sepsis or shock, hypoxia, severe anemia, hypertensive emergency
- injury without ischemia → heart failure, myocarditis, Takotsubo, PE, CKD, stroke / SAH, CPR, cardioversion, chest trauma, recent PCI or CABG
- chronic, flat → CKD, structural heart disease
send now
- repeat troponin at 1 h (0/1h pathway) or 3 h, ECG with each; use your lab’s assay cut-offs
- CBC, RFT, glucose; CXR
- heart failure or new murmur → echo; PE suspected → D-dimer / CTPA; unwell → VBG, lactate, cultures
interpretation
- rise or fall + ischemic symptoms or ECG → type 1 MI: ACS pathway
- rise or fall + an obvious stressor → type 2 MI: treat the stressor
- raised but flat on repeat → chronic injury (CKD, structural heart disease), not ACS
- in the 1000s → MI or myocarditis; PE and Takotsubo usually modest
- after PCI / CABG a rise is expected: compare with the pre-procedure value; > 10× ULN with symptoms or ECG change → cardiology
calculator HEART score · MDCalc ↗︎
treat
- suspected ACS → aspirin 300 mg PO chewed now (unless allergy or active bleeding), ECG, cardiology now
- type 2 → treat the cause: oxygen, rate control, antibiotics, transfusion, BP
- injury → treat the underlying illness; echo in the morning if none obvious
- ongoing pain, dynamic ECG or troponin, instability, arrhythmia, new heart failure → cardiology now
- hand over → last troponin + trend, next repeat due, escalation trigger
evidence
| source | type |
|---|---|
| Universal Definition of Myocardial Infarction (Type 1–5 classification) | international guideline |
| ESC 2023 ACS Guidelines (0/1h and 0/2h hs-cTn pathways) | international guideline |
Verify indication, dose, allergies, interactions, renal/hepatic function and local protocols before prescribing.
free the on-call checklist covers the whole shift on one printable page.
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updated Oct 2026file lab/troponin