The increased troponin used to be a straight ticket to the cardiology service. Now, the picture isn't so clear. What do you need to consider in the patient with elevated troponin? Cardiac troponins consist of three proteins: cTnC, cTnI, and cTnT1. These proteins interact with tropomyosin to form a complex that functions as the backbone of striated muscle. This functions in the excitation and contraction coupling of the heart through modulation of actin-myosin interaction in muscle.

A troponin elevation does not mean it’s ACS. At the end of the day, troponin is a tool and nothing more. Physicians must take into account the entire clinical picture: history, exam, ECG, baseline labs, response to treatment, clinical gestalt, etc.

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