Troponin is used to help diagnose Acute Coronary Syndrome (ACS); with acute elevations indicating myocardial injury that occurs with unstable angina or myocardial infarction. Troponin can also be used to predict severity of disease in pulmonary embolism (PE). The increased back pressure on the heart from a PE causes troponin to be released from the myocardium. The higher the troponin level, the greater the stress on the heart and the more risk for hemodynamic collapse.
A recent study shows that troponin can also be used to predict risk for death in patients with transient ST-segment elevation. Patients with elevated troponins had a 41% greater risk of death.
The mechanism for the elevated troponin in transient ST-segment elevation is probably the same as it is for PE – stress on the heart. The more stress, the greater the troponin level. This information may give you clues to your patient's hemodynamic stability. When troponin levels are high, it is an indication of higher levels of cardiac stress. Watch this patient carefully. It is likely that the patient with high troponin levels will be more hemodynamically unstable, and will have a higher risk of sudden cardiac death.
From:
American College of Emergency Physicians 38th Annual Scientific Assembly: Abstract 22. Presented October 8, 2007.
Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
Alumnus CCRN
President, Ed4Nurses, Inc.
http://www.ed4nurses.com/