Why is her troponin up?

by Bob Stuntz

A 50 year old female presents to the ED with complaints of chest tightness.  She says it started around 6 hours ago, and has been relatively constant.  It is left sided and non-radiating.  Her brother was in a car accident that she witnessed earlier today, and she thinks she is just stressed, but her husband made her come in to get checked out.  She has no significant CAD risk factors, and no real medical problems.  She was given some Ativan, which has helped with the chest pain.  

You review her EKG and CXR, which are non-diagnostic.  As you are planning on sending her home, thinking someone with a stress reaction and a 6 hour negative troponin with no significant CAD risk factors can be managed as an outpatient, you see her troponin come back…at 0.54.  

What is going on?  Why does she have an elevated troponin?  What do you expect to see on the heart cath?  Answers to come…