Troponin Elevation DDx

• ACS (STEMI or NSTEMI)
• Tachy or bradyarrhythmias, or heart block
• Critically ill patients, especially with diabetes, respiratory failure or sepsis
• Hypertrophic cardiomyopathy
• Coronary vasospasm
• Acute neurological disease, including stroke or subarachnoid hemorrhage
• Cardiac contusion or other trauma (including surgery, ablation, pacing, ICD shocks, etc.)
• Rhabdomyolysis with cardiac injury
• Congestive heart failure - acute and chronic
• Pulmonary embolism, severe pulmonary hypertension
• Renal failure (still implies cardiac damage; not ALL pts with CRI have + troponins)
• Aortic dissection
• Aortic valve disease
• Takotsubo or stress-induced cardiomyopathy (apical ballooning syndrome )
• Infiltrative diseases (ie, amyloidosis, hemochromatosis, sarcoidosis, and scleroderma)
• Inflammatory diseases (ie, myocarditis or myocardial extension of endo-/pericarditis, Kawasaki disease)
• Drug toxicity (ie, adriamycin, 5-flurouracil, herceptin, snake venom)
• Burns, especially if affecting >25 percent of body surface area
• Extreme exertion 

(Victoria Kelly MD, 1/25/11)