Disproportionate Elevated Troponin T Without Clinical Ischemia: A Diagnostic Challenge in the Emergency Department

Background: Cardiac troponins (cTns) are essential for evaluating chest pain, but elevated levels can arise from noncardiac causes or laboratory artifacts. Confirmatory testing for assay interference is often unavailable for false-positive cases, complicating diagnosis and management. Case Summary: A 62-year-old female presented with chest pain and disproportionally elevated high-sensitivity troponin T (hs-cTnT) levels (8396 ng/L). Clinical evaluation, including EKG, echocardiography, and nuclear myocardial perfusion images showed no evidence of acute ischemia. Noncardiac causes of elevation of troponins, as well laboratory artifacts, were considered as differential diagnostics. A clinically driven approach was adopted to resolve this case. Conclusion: In cases of disproportionally troponin elevation, a clinically driven approach incorporating risk stratification and alternative diagnostic tools, such as nuclear imaging, can effectively guide management and avoid unnecessary interventions.