What is troponin?
Troponins are proteins found in the cardiac and skeletal muscles. When the heart is damaged, it releases troponin into the bloodstream. Doctors measure your troponin levels to detect whether or not you’re experiencing a heart attack. This test can also help doctors find the best treatment sooner.
Troponin is more sensitive. Measuring cardiac troponin levels in the blood allows doctors to diagnose a heart attack or other heart-related conditions more effectively, and provide immediate treatment.
Troponin proteins are split into three sub-units:
- troponin C (TnC)
- troponin T (TnT)
- troponin I (TnI)
What are normal levels of troponin?
In healthy people, troponin levels are low enough to be undetectable. If you’ve experienced chest pain, but troponin levels are still low 12 hours after the chest pain started, the possibility of a heart attack in unlikely.
High levels of troponin are an immediate red flag. The higher the number, the more troponin, specifically troponin T and I, has been released into the bloodstream and the higher the likelihood of heart damage. Troponin levels can elevate within 3-4 hours after the heart has been damaged and can remain high for up to 14 days.
Troponin levels are measured in nanograms per millilitre. Normal levels fall below the 99th percentile in the blood test. If troponin results are above this level, it may be an indication of heart damage or heart attack. However, recent research suggests that women can experience heart damage from a heart attack at levels below the current “normal” cut off. This means that in the future, what’s considered normal may differ for men and women.
What causes high troponin levels?
Though a rise in troponin levels are often an indication of a heart attack, there are a number of other reasons why levels could elevate.
Other factors that could contribute to high troponin levels include:
- intense exercise
- extensive infection, like sepsis
- myocarditis, an inflammation of the heart muscle
- pericarditis, an inflammation around the sac of the heart
- endocarditis, an infection of the heart valves
- cardiomyopathy, a weakened heart
- heart failure
- kidney disease
- pulmonary embolism, a blood clot in your lungs
- hypothyroidism, an underactive thyroid
- intestinal bleeding
What is a troponin test?
A troponin test is a measure of troponin T or I levels in the blood and is used to detect small degrees of damage to heart muscle cells (myocytes). Most cardiologists and emergency physicians interpret this as an indication of a heart attack (myocardial infarction).
Troponin T and troponin I are proteins found only in heart muscle tissue. Although there are some medical conditions in which troponin is slightly raised without damage to heart muscle (especially in patients on dialysis for chronic renal failure), troponins are normally not detectable in the bloodstream.
How a troponin test performed?
A troponin test is a blood test that requires a few millilitres of blood from a vein. The timing of the test is also important; to be reliable it needs to be taken at least 6 to 12 hours after the onset of chest pain or other symptoms.
What are the symptoms to check the troponin test?
Your doctor will recommend this test if you’re experiencing chest pain or related heart attack symptoms including:
- pain in the neck, back, arm, or jaw
- intense sweating
- shortness of breath
After taking a blood sample, your doctor will assess your troponin levels to diagnose a heart attack. They’ll also look for any changes on an electrocardiogram (ECG), an electrical tracing of your heart. These tests may be repeated several times over a 24-hour period to look for changes. Using the troponin test too soon can produce a false-negative. Increased levels of troponin can take hours before being detectable.
If your troponin levels are low or normal after experiencing chest pain, you may not have experienced a heart attack. If your levels are detectable or high, the likelihood of heart damage or heart attack is high.
In addition to measuring your troponin levels and monitoring your ECG, your doctor may want to perform other tests to examine your health, including:
- additional blood tests to measure cardiac enzyme levels
- blood tests for other medical conditions
- an echocardiogram, an ultrasound of the heart
- a chest X-ray
- a computed tomography (CT) scan
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