Overview Troponin I Normal value range Pathophysiology Special considerations Elevations in lab values Nursing Points General Normal value range Typically, less than 0.035 ng/mL or less Can vary among institutions Has to be greater than the 99th percentile Pathophysiology Troponin is released during myocardial cell damage Decreased perfusion causes myocardial cell damage Causes of myocardial cell damage Myocardial infarction Demand ischemia Cardiogenic ACS Noncardiogenic Sepsis Renal failure Extreme exercise Special considerations Submitted in green top tube Value peak Detection 6-12 hours after acute injury Peaks 24 hours after injury Can stay elevated for a week Knowing patient history is critical Increased values Any elevated value is typically considered critical Acute elevations warrant immediate investigation Typically PCI (percutaneous coronary intervention)/Angiography and EKG to rule out MI or ACS (acute coronary syndrome) Other elevations CABG Extreme exercise End Stage Renal Failure Assessment Assess for: Acute chest pain Symptoms of MI Nausea Vomiting Angina in any form Reflux (especially in women) Therapeutic Management EKG Angiography or PCI Management of non-cardiogenic etiology Nursing Concepts Lab Values Perfusion Patient Education Educate patient on keeping history of elevated levels or cardiac disease for future reference Educate patient on duration of elevated troponin levels, post injury