Troponin

• 99th %ile w/ rise and/or fall in approp. setting is dx of AMI (Circ 2018;138:e618)

Fourth Universal Definition of Myocardial Infarction (2018)

• High-sens Tn (hsTn) detectable 1 h after injury, peaks ~24 h, can be elevated for >1 wk
• ✓ at presentation & 1–3 h later;
  • repeat if clinical or ECG ∆s;
  • assess absolute level & Δ

Ddx of elevated cTnI 小麻的定義

大概分

1 [plaque rupture]

2 [supply-demand mismatch not due to Δ in CAD)

• Reduced myocardial perfusion

  • Coronary artery spasm, micorvascular dysfunction
  • Coronary embolism
  • Coronary artery dissection
  • Sustained bradyarrhythmia
  • hypotension or shock
  • respiratory failure
  • severe anemia

• Increased myocardial oxygen demand

  • sustained tachyarrhythmia
  • severe hypertension with or without left ventricular hypertrophy

non-ischemic cardiac

• myocarditis,
• ADHF, Takotsubo, defibrillation, contusion
• coronary revascularization procedcure
• catheter ablation

systemic illness

• PE, PHT, stroke, SAH, critical illness
• sepsis
• amyloidosis, sarcoidosis
• chemotherapy agents
• strenous 費力的