ECG Challenges: Interpretation of Serum Troponin Elevation
Gerard B. Hannibal RN, MSN, PCCN
Gerard B. Hannibal RN, MSN, PCCN; Department Editor

$3.95 		AACN Advanced Critical Care
June 2013 
Volume 24  Number 2
Pages 224 - 228
 
  PDF Version Available!

ABSTRACT
This month's column takes a slight detour from the electrocardiogram (ECG) to look at the closely related topic of interpretation of serum cardiac troponin (cTn) elevation. One of the challenges of ECG interpretation for coronary disease is the lack of specificity and sensitivity of the 12-lead ECG. Statistically, the ECG by itself frequently fails to rule in myocardial infarction (MI) when present and fails to rule out MI when not present. Except for the case of frank ST-segment elevation MI (STEMI), the diagnosis of acute coronary syndrome (ACS) depends on a combination of indicators, such as ECG, physical examination, imaging, history, and risk factor assessment. Working as acute and critical care nurses, we often find ourselves involved in the collection and interpretation of biomarkers, followed by our involvement in the rapid treatment of patients with ACS.Various biomarkers, including creatine kinase, lactate dehydrogenase, myoglobin, heart-type fatty acid binding protein (H-FABP), and cTn, for cardiac injury have been used over the years. The marker cTn, in use for the past 20 years, is currently the criterion standard for rapid confirmation of working myocardial cell damage and has become a mainstay in the diagnostic armamentarium for ACS. After 2 decades of use, however, we know that not all cTn elevations are due to MI related to plaque rupture. Troponin elevation occurs in ACS, non-ACS MI, and various acute and chronic conditions. This ECG Challenges column reviews the use of the biomarker cTn on the basis of a newly published expert consensus document1 and example case studies.A patient presented with chest pain and exacerbation of heart failure as a result of fluid overload. Serum type B natriuretic peptide level was 1280 pg/mL (reference range, 0.00-99.0 pg/mL), and the cTn level was 0.08 ng/mL (reference range, 0.00-0.06 ng/mL). The patient described the pain as a nonradiating chest pressure that was completely relieved with sublingual nitroglycerin.

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