II. Epidemiology
- Serum Troponin Increase is common (40% of patients) in ICU patients admitted for non-cardiac causes
III. Precautions
- Avoid ordering Troponin In the absence of signs or symptoms of cardiac event
IV. Imaging
-
Echocardiogram
- May be best non-invasive bedside tool for differentiating cause of Troponin Increase
V. Evaluation: Distinguish Type I MI (Plaque rupture) from Type II MI (demand ischemia)
- Type 1 Myocardial Infarction (Plaque rupture with acute coronary Occlusion)
- Echocardiogram with wall motion abnormalities
- Uncommon in the ICU if admitted for other cause
- Treat with Aspirin and Platelet ADP Receptor Antagonist (e.g. Plavix)
- Consider cardiac catheterization if possible given patient status
- Heparin is indicated if cardiac catheterization is planned (avoid otherwise)
- Type 2 Myocardial Infarction (demand ischemia with fixed lesion)
- Echocardiogram with hyperdynamic heart activity
- Manage reversible causes of ischemia (Hypoxia, Anemia, shock)
- Give Aspirin
VI. Resources
- Internet Book of Critical Care (EMCRIT.org)