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More than one third of patients will have chest pain associated with Supraventricular Tachycardia (SVT). It is unclear if Troponin markers in this setting are useful in predicting which patients will have Coronary Artery Disease (CAD). Elevated Troponins are not pathognomonic for CAD or acute coronary syndrome. In fact, modest Troponin elevation is well documented in patients with SVT with normal coronary angiography and is thought to be due to cardiac stretch, poor diastolic perfusion, and/or coronary artery vasospasm. Routine ordering of Troponin in patients with SVT who convert easily to sinus rhythm could potentially result in unnecessary testing and admission. Given the high incidence of Troponin elevation in patients with SVT, we sought to evaluate the literature and determine the prognostic value of Troponin assays in patients presenting to the emergency department with SVT. The routine ordering of Troponin in patients with SVT is not supported. Further testing and admission should be reserved for patients who have persistent symptoms after conversion to normal sinus rhythm, abnormal electrocardiograms after conversion to normal sinus rhythm, or those who have significant risk and pre-test probability for underlying coronary artery disease. Other patients may be appropriate for outpatient evaluation and electrophysiology studies.
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