Down the Troponin Rabbit Hole

The 2018 Fourth universal definition of myocardial infarction (MI), adopted by the National Institute for Clinical Excellence (NICE), states that a diagnosis of MI can be made with “evidence of a rise (or fall) of cardiac biomarkers with one value above the 99th percentile upper reference range and at least one” other feature.^1,2

List 2 features, that when combined with an elevated tronopin level, would support the NICE definition and diagnosis of an MI.

(0.5 marks for each correct answer; maximum 1 mark)

State one other likely, non-cardiac diagnosis that could have caused an elevated troponin level in this patient?

Provide one clinical feature to support your answer.  (1 mark)

An ultrasound clinical fellow is in the emergency department. They perform an echocardiography and comment that the right ventricle is abnormal. State two possible observations.

(0.5 marks for each correct answer; maximum 1 mark)