Cardiac troponin is the current gold standard diagnostic biomarker of myocardial injury in both acute and subacute cardiac disease. Even small elevations in troponins correlate with higher risk of death and recurrent ischemic events in ACS patients. Patients with elevated troponins benefit most from more intensive medical therapy and early invasive management. On the other hand, troponins do not discriminate between ischemic and non-ischemic causes of myocardial injury and the clinical presentation is crucial. False-positive troponin results are under-recognised and can have significant downstream consequences. Clinicians with a role in diagnosis, initial management and ongoing care of patients with cardiac disease require an understanding of the current methods of troponin testing, causes of falsely elevated results and a systematic approach to further testing to prevent ongoing misdiagnosis. We report a case series of eleven patients who attended a small regional hospital in Queensland, Australia in a 12-month period. The patients were aged between 53 – 86 years and most presented with chest pain and/or dyspnoea. The patients’ demographic data, presenting symptoms, clinical suspicion, diagnostic testing and outcomes were examined. All cases demonstrated elevated troponin levels that initially raised concern for ACS, however subsequent investigations excluded myocardial ischemia. All cases were ultimately attributed to analytical interference. This series highlights the diagnostic challenges posed by spurious troponin elevations and the downstream clinical impact, including patient anxiety, cardiology referrals, invasive investigations and increased hospital length of stay. Clinicians need to maintain diagnostic vigilance when troponin results are inconsistent with the clinical picture. A systematic approach, including confirmatory assays and multidisciplinary review is essential to avoid misclassification and inappropriate treatment and optimise patient outcomes.

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