We need to address the issue of "mild troponinaemia"

doi:10.1136/bmj.b769

Published 24 February 2009, doi:10.1136/bmj.b769
Cite this as: BMJ 2009;338:b769

Letters

Myocardial infarction

We need to address the issue of "mild troponinaemia"

The first 150 words of the full text of this article appear below.

The new definition of myocardial infarction (MI) is timely butdoes not address the main issue of mild troponinaemia and overdiagnosis.¹² Slight increases in troponin are often seen in patients withmultiple comorbid conditions such as diabetes and heart or kidneyfailure who present with dyspnoea, infections such as pneumonia,exacerbation of chronic obstructive lung disease, or atypicalsymptoms.³ These patients, no doubt, are at increased risk ofcardiovascular mortality.⁴ However, these episodes do not fulfilthe definition of acute myocardial infarction but are oftendiagnosed as "non-ST elevation MI (NSTEMI)," increasing theincidence of myocardial infarction.²

Labelling all cases of cardiac arrest as type 3 myocardial infarctionundermines the importance of other treatable causes, whereasestablishing a correct diagnosis is important to tailor treatmentand advocate preventive strategies in family members. Similarly,dividing myocardial infarction following cardiac proceduresinto two types (4 and 5) doesn’t make sense when it . . . [Full text of this article]

Malvinder S Parmar, associate professor¹

¹ Clinical Sciences Division, Northern Ontario School of Medicine, 640 Ross Avenue East, Suite E, Timmins, ON, Canada P4N 8P2

atbeat@ntl.sympatico.ca