Non-ACS Myocardial Injury - Elevated Troponin Differential Diagnosis and Workup Algorithm
• Chronic Myocardial Injury: End Stage Renal Disease, Structural Heart Disease (ie HCM), Infiltrative Process (ie Sarcoid), Chronic Inflammation
• Globally Abnormal or Normal
- Impaired O2 Delivery (Pre-Coronarv): Shock, Hypoxemia, Anemia
- Global Direct Iniury (Post-Coronarv): Stress (ie Sepsis-induced CM), Metabolic (ie acidosis), Tachycardia-induced HF, Severe Volume Overload/HTN
• Focal, Non-Vascular Distribution: Acute Myocarditis, Catecholamines (Takutsubo), Toxins, Contusion/Trauma
• No Obstruction (MINOCA): Transient Intra-Coronary Process (ie Spasm or Embolism), Microvascular CAD, Focal Direct Injury (Post-Coronary)
• Acute Occlusion
• Stable CAD
Dr. Johnny Hourmozdi @JHourmozdi
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