skip to main content

PE Troponin — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRespiratoryPE TroponinRACP Adult Medicine

A 55-year-old man presents with acute pleuritic chest pain, dyspnoea, and tachycardia. Troponin is 350 ng/L. ECG shows S1Q3T3 pattern and sinus tachycardia. CTPA shows bilateral pulmonary emboli with RV strain (RV:LV ratio 1.3). Echo shows RV dilatation and hypokinesis. What is the most likely cause of raised troponin?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Pulmonary embolism

Elevated troponin in PE indicates RV myocardial injury from acute pressure overload — a marker of submassive PE (intermediate-risk). The combination of RV dysfunction on echo PLUS elevated troponin identifies intermediate-high risk PE (mortality ~5-15%). These patients may benefit from close monitoring (ICU/HDU), systemic anticoagulation, and consideration of rescue thrombolysis if haemodynamic deterioration occurs.

Reference: ESC – 2019 – PE Guidelines; eTG Haematology 2024