• Burns, especially if TBSA greater than 30%

• Infiltrative diseases, including amyloidosis, hemachromatosis, sarcoidosis, and scleroderma

• Acute neurologic disease, including CVA, subarchnoid bleeds

• Rhabdomyolysis with cardiac injury

• Transplant vasculopathy

• Vital exhaustion which pulmonary embolism albeit in the right rather than the left ventricle, induces injury.

2. Cardiac toxicity as a result of drugs, snake bites, or other toxins in the environment are certainly capable of causing troponin elevations. Heat shock protein or TNF are believed to participate in cardiac injury seen with sepsis.

3. Myocarditis, acute or chronic, can cause troponin elevations and a series of patients who might be confused with those suffering with STEMI has been published. The diagnosis should be considered in patients initially suspected of having acute coronary syndromes who have normal coronary arteries.

4. Cardiomyopathies, congestive or infiltrative, and congestive heart failure likely caused by wall stress and reduced subendocardial perfusion are also capable of leading to elevated troponins and have significant prognostic significance.

5. Critically ill patients. A large body of information suggests that elevations in troponin are common and highly prognostic in patients who are critically ill whether in the hospital or ED.

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