# Disproportionate Elevated Troponin T Without Clinical Ischemia: A Diagnostic Challenge in the Emergency Department

## TL;DR

A patient with very high troponin levels but no heart issues shows the challenge of diagnosing non-cardiac or lab-related causes in emergency settings.

## Contribution

Presents a case where clinical evaluation and nuclear imaging helped manage a diagnostic challenge with elevated troponin T.

## Key findings

- A 62-year-old female had extremely high troponin T levels without signs of heart attack.
- Clinical and imaging evaluations ruled out acute ischemia and suggested non-cardiac or lab-related causes.
- Using risk stratification and nuclear imaging helped guide management and avoid unnecessary treatments.

## Abstract

Cardiac troponins (cTns) are essential for evaluating chest pain, but elevated levels can arise from noncardiac causes or laboratory artifacts. Confirmatory testing for assay interference is often unavailable for false‐positive cases, complicating diagnosis and management.

A 62‐year‐old female presented with chest pain and disproportionally elevated high‐sensitivity troponin T (hs‐cTnT) levels (8396 ng/L). Clinical evaluation, including EKG, echocardiography, and nuclear myocardial perfusion images showed no evidence of acute ischemia. Noncardiac causes of elevation of troponins, as well laboratory artifacts, were considered as differential diagnostics. A clinically driven approach was adopted to resolve this case.

In cases of disproportionally troponin elevation, a clinically driven approach incorporating risk stratification and alternative diagnostic tools, such as nuclear imaging, can effectively guide management and avoid unnecessary interventions.