title: [Diagnostic and Therapeutic Implications of Elevated Plasma Troponin in Acute Exacerbated Chronic Obstructive Pulmonary Disease].
abstract: OBJECTIVE
  Cardiovascular comorbid conditions are frequent in chronic obstructive pulmonary disease (COPD) and substantially influence morbidity and mortality. Elevated plasma levels of cardiac troponin have been detected in up to 74 % of patients with acute exacerbated COPD (AECOPD), pointing at concomitant myocardial damage that can primarily be ascribed to systemic inflammatory processes. The mechanisms promoting troponin release in AECOPD are manifold and comprise: type 1 myocardial infarction as a consequence of intraluminal thrombus formation, type 2 myocardial infarction due to an imbalance between myocardial oxygen supply and demand, as well as right and left heart failure. Given its multifactorial aetiology, no standardized diagnostic and therapeutic approach are as yet available.
  
  
  METHODS
  On the basis of current literature, we propose a potential diagnostics and therapeutics algorithm for AECOPD patients with elevated troponin levels.
  
  
  RESULTS
  Clinical presentation, electro- and echocardiogram, as well as cardiac troponin levels and their dynamics represent sufficient risk stratifiers that permit evaluation and timing of invasive coronary strategy.
  
  
  CONCLUSIONS
  The necessity for a standardized approach to elevated troponin during AECOPD arises from the frequent presence of concomitant coronary heart disease and the potential risk of oversight of type 1 myocardial infarction.
authors.affiliation: Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II - Kardiologie, Pneumologie, Angiologie.
authors.forename: C
authors.initials: C
authors.lastname: Pizarro
authors.affiliation: Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II - Kardiologie, Pneumologie, Angiologie.
authors.forename: F
authors.initials: F
authors.lastname: Jansen
authors.affiliation: Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II - Kardiologie, Pneumologie, Angiologie.
authors.forename: N
authors.initials: N
authors.lastname: Werner
authors.affiliation: Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II - Kardiologie, Pneumologie, Angiologie.
authors.forename: G
authors.initials: G
authors.lastname: Nickenig
authors.affiliation: Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II - Kardiologie, Pneumologie, Angiologie.
authors.forename: D
authors.initials: D
authors.lastname: Skowasch
mesh_terms: D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis* / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D018570:Risk Assessment / Q000379:methods; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D014336:Troponin