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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