Non-coronarogenic causes of increased cardiac troponins in the practice of physicians (literature review)

Cardiac isoforms of troponins are the most sensitive and specific biomarkers of myocardial damage and new high-sensitivity methods can reveal very minor damages on the heart muscle. However, elevated troponin levels indicate cardiac damage, but do not define the cause of the damage. Therefore, cardiac troponin elevations are common in many disease states and do not necessarily indicate the presence of acute myocardial infarction. In clinical practice, interpretation of positive troponins may be challenging. In our article, we consider the main non-coronarogenic causes of increased cardiac troponins. The first part of the review discusses the mechanisms of increase and the diagnostic value of cardiac troponins during physical exertion, inflammatory and toxic myocardial injuries (endocarditis, myocarditis, sepsis), and renal failure. The second part of the literature review describes the mechanisms of increase and the diagnostic value of troponins in pulmonary thromboembolism, dissecting aortic aneurysms, neurogenic pathologies (stroke, subarachnoid hemorrhages), and treatment with cardiotoxic drugs (chemotherapy). Special attention is paid to the false positive causes of elevation of troponins.