TROPONIN

Troponin is a protein found in muscle cells for contraction. Three subunits of Troponin
(Troponins I, C, T) are present in all muscle types however the cardiac isoform T and I are only
expressed in cardiac muscles and are normally present in very small to undetectable quantities
in the blood.
Damage to cardiac muscles result to increase in serum cTnI and cTnT
When the myocardial damage occurs the cytosolic troponins reach the blood
stream quickly resulting in a rapid peak of serum troponin observed during the
first few hours.
When a person has a heart attack, levels of cardiac-specific troponins I and T
can become elevated in the blood within 3 or 4 hours after injury and may remain
elevated for 10 to 14 days.
A blood sample is taken by needle from a vein in the arm
Troponins are the preferred tests for a suspected heart attack because they are
more specific for heart injury than other tests (which may become positive in
skeletal muscle injury) and remain elevated for a longer period of time.
In people with stable angina, a troponin test may be ordered when:
Symptoms worsen
Symptoms occur when a person is at rest
Symptoms are no longer eased with treatment
These are all signs that the angina is becoming unstable, which increases the risk of
a heart attack or other serious heart problem in the near future.

The test is not affected by damage to other muscles, so injections, accidents,
and drugs that can damage muscle do not affect cardiac troponin levels.
Troponin may rise following strenuous exercise, although in the absence
of signs and symptoms of heart disease, it is usually of no medical significance.
Troponin levels may also be elevated with acute or chronic conditions such as
myocarditis (heart inflammation), congestive heart failure, severe
infections, kidney disease, and certain chronic inflammatory conditions of
muscles and skin.
Test results are usually considered normal if the results are:
Troponin I : less than 10 g/L
Troponin T : 00.1 g/L
Normal troponin levels 12 hours after chest pain has started mean a heart attack
is unlikely.






Troponin

From Differential Diagnosis of Elevated Troponins
Susanne Korff, Hugo A Katus, Evangelos Giannitsis

The cardiac isoforms troponin T and I are only expressed in cardiac
muscle.
Hence, cardiac troponin T (cTnT) and I (cTnI) are more specific than
creatine kinase (CK) values for myocardial injury,
Because of their high sensitivity, they may even be elevated when CK-MB
concentrations are not
In the year 2000, the European Society of Cardiology and the American
College of Cardiology jointly redefined myocardial infarction (MI) by an
elevation of cardiac troponin T (cTnT) or I (cTnI) in conjunction with clinical
evidence of myocardial ischaemia


From European Heart Journal, Troponin Elevation in Coronary vs. Non-Coronary
Disease
S. Agewall, E. Giannitsis, T. Jernberg, and H. Katus
http://eurheartj.oxfordjournals.org/

Both troponin T and I are ideally suited for the detection of myocardial
damage as they are expressed as cardio-specific isoforms.
However, elevated cTn levels indicate cardiac injury, but do not define the
cause of the injury

From Cardiac Enzymes and Markers for Myocardial Infarction
www.patient.co.uk/doctor/cardiac-enzymes-and-markers-for-myocardial-
infarction

Troponin is a contractile protein the normally is not found in serum. It is
released only when myocardial necrosis occurs

Yo! di ako makapasok sa site ng ibang journals for the mechanism of release ng
troponin but I got this one from Medscape
Heres the link! http://www.medscape.com/viewarticle/771065_6
How to Use High-Sensitivity Cardiac Troponins in Acute Cardiac Care
Kristian Thygesen, Johannes Mair, Evangelos Giannitsis, Christian Mueller, Bertil
Lindahl, Stefan Blankenberg, Kurt Huber, Mario Plebani, Luigi M. Biasucci, Marco
Tubaro, Paul Collinson, Per Venge, Yonathan Hasin, Marcello Galvani, Wolfgang
Koenig, Christian Hamm, Joseph S. Alpert, Hugo Katus, and Allan S. Jaffe


Figure 1.
Template for rapid early rule-in of acute myocardial infarction with high-sensitivity
cardiac troponin displaying an algorithm for clinical use of high-sensitivity cardiac
troponin testing based on current knowledge. It should be noted that the stated
algorithm may vary according to the troponin assay evaluated. This approach optimizes
sensitivity for acute myocardial infarction diagnosis, but clinicians may also wish to
choose more stringent metrics to improve specificity (see text). AMI, acute myocardial
infarction; hs-cTn, high-sensitivity cardiac troponin; URL, 99th percentile upper
reference limit. *Evidence of ischaemia by symptoms and/or new electrocardiogram
changes and/or new imaging corroboration.