Troponin T versus Troponin I Acute Myocardial Infarction in a 63 Year Old Female with an Acute Cervical Spinal Cord Injury after Post-Operative Debridement

Background: Chronically elevated Troponin T (cTnT) in neurodegenerative and neuromuscular diseases is a recognized but underappreciated phenomenon, often leading to diagnostic challenges. This is particularly critical in spinal cord injury (SCI) patients, where physical examination is limited and atypical presentations of acute coronary syndromes are common. Distinguishing true myocardial infarction from false-positive cTnT elevation is essential to avoid unnecessary interventions. Case Presentation: A 63-year-old female with chronic T4 paraparesis presented with an acute cervical SCI. Following a surgical debridement, she developed acute dyspnea, hypotension, bradyarrhythmia, and hypoxia. Bedside echocardiogram revealed antero- and inferoseptal hypokinesia. Serial biomarkers showed a >20% rise in both cTnT (96.4 to 264 pg/mL) and Troponin I (cTnI) (0.110 to 0.610 µg/L), meeting criteria for non-ST-elevation myocardial infarction (NSTEMI). However, while cTnI normalized within days, cTnT remained persistently elevated (42.1 pg/mL) one month post-event, against a backdrop of chronic muscle atrophy and severe pressure ulcers. Conclusion: This case highlights the diagnostic utility of cTnI in the SCI population. In patients with chronic neuromuscular degeneration, cTnI demonstrates the expected rise-and-fall dynamic of an acute myocardial injury, whereas cTnT exhibits chronic elevation likely due to skeletal muscle pathology. For the differential diagnosis of NSTEMI in SCI patients, cTnI appears to be a more reliable biomarker, potentially preventing misinterpretation and unnecessary cardiac interventions.