Elevated troponins are relatively common. They occur when there is a myocardial infarction , but they can also occur in other situations such as pulmonary embolism, heart failure, myocarditis or end-stage renal disease (ESRD). If the elevated troponins are associated with chest pain and/or distinct EKG changes, the patient could be having a myocardial infarction (MI), which could be related to a ST elevation or not. Not all MI’s are caused by an acute obstruction of a coronary artery. In some cases, there is what is called a supply/demand mismatch¹. This situation may also called the type 2 myocardial infarction. It is important to document this entity as such, always in agreement with the cardiologist, if one is involved in the case.

Marco A. Ramos MD, CCDS

References

1. Remer, Erica. “Learning ICD-10: Documenting Type 2 Myocardial Infarction” icd10monitor.com. https://www.icd10monitor.com/learning-icd-10-documenting-type-2-myocardial-infarction (accessed September 16, 2018).

In order to quote from this article please use the following:

Marco A. Ramos, “Clinical Documentation Improvement Series #8. The Importance of “Present on Admission”,” SMO Blog (blog), September 16, 2018, https://steemit.com/health/@secondmedicalop/clinical-documentation-improvement-series-9-if-the-patient-has-elevated-troponins

Links to the Previous Posts in this Series

- Clinical Documentation Improvement Series #1. Documenting Acute Respiratory Failure

- Clinical Documentation Improvement Series #2. How and When Do We Use the Body Mass Index (BMI)

- Clinical Documentation Improvement Series #3. Is it Delirium or Encephalopathy?

- Clinical Documentation Improvement Series #4. Documenting Myelopathies and Radiculopathies

- Clinical Documentation Improvement Series #5. Documenting Electrolyte Imbalances.

- Clinical Documentation Improvement Series #6. Documenting Electrolyte Imbalances.

- Clinical Documentation Improvement Series #7. Documenting Electrolyte Imbalances.

- Clinical Documentation Improvement Series #8. The Importance of “Present on Admission”

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