Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate
Do not wait for troponin when the ECG shows STEMI or there is ongoing ischaemia, shock or a life-threatening arrhythmia; activate urgent reperfusion or senior assessment immediately.
Synopsis
Interpret high-sensitivity troponin as a time-dependent marker of myocardial injury and integrate it with symptoms, ECG and the assay-specific pathway.
Cardiac troponin above the assay's 99th-centile upper reference limit defines myocardial injury, not its cause.
Acute injury requires a rise or fall; myocardial infarction additionally requires clinical evidence of acute ischaemia.
Use the validated sampling times and thresholds for the exact high-sensitivity assay in your laboratory.
Key red flags
STEMI despite pending biomarkers
Persistent diagnostic ST elevation with a compatible presentation is a reperfusion diagnosis; troponin delay can cost myocardium.
Investigation priorities
01
Serial high-sensitivity cardiac troponinFirst step
Detect or exclude acute myocardial injury.
Management branches
Preferred routeSuspected NSTE-ACS
Compatible symptoms without diagnostic persistent ST elevation
Obtain ECG and first high-sensitivity troponin promptly, documenting symptom-onset time.
Apply the exact assay's validated early rule-out or serial algorithm; repeat ECG and troponin if indicated.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.