🫀 Coronary Occlusion to Troponin Rise Timeline Simulator

Coronary Artery Occlusion

A ruptured plaque triggers thrombus formation that blocks coronary flow.

• Seconds: Typical onset (Plaque rupture to clot)
• LAD/RCA/LCx: Vessel (Culprit artery)
• 0%: Flow (Total occlusion)
• Chest pain: Symptom (Classic presentation)

Thrombus formation

Ruptured plaque exposes lipid core, platelets aggregate, clot forms.

Time zero for the ischemic clock starts here.

Myocardial Ischemia Onset

Oxygen deprivation begins within seconds downstream of the blockage.

• <2 min: ATP depletion (Anaerobic shift)
• High early: Reversibility (If reperfused fast)
• ST shift: ECG change (Early marker)
• Minutes: Pain onset (Symptom trigger)

Metabolic starvation

Cells switch to anaerobic metabolism as oxygen supply collapses.

Ischemia is reversible if flow returns quickly.

Cell Necrosis Begins

Sustained ischemia causes myocyte membranes to rupture irreversibly.

• ~20-40 min: Necrosis start (Wavefront begins)
• Subendo→epi: Pattern (Wavefront spread)
• ~20 min: Point of no return (Irreversible injury)
• Begins: Marker leak (Membrane rupture)

Wavefront necrosis

Death spreads from inner to outer heart wall the longer flow stays blocked.

Time is muscle — every minute of occlusion adds necrotic tissue.

Troponin Release Into Blood

Dying cells spill troponin, which diffuses into the bloodstream over hours.

• ~1-3h: First detectable (High-sensitivity assay)
• ~12-24h: Peak level (After occlusion)
• ~2h: Half-life (Clearance rate)
• High: Specificity (Cardiac-specific)

Blood-level kinetics

Troponin rises steeply after a lag, tracking infarct size and time.

Bigger infarcts release troponin faster and higher.

Diagnostic Window & Serial Testing

Serial troponin draws close the early diagnostic gap of normal first tests.

• 0h & 1-3h: Serial draw (hs-cTn protocol)
• Low: Early sensitivity (Before ~3h)
• >95%: Late sensitivity (By ~6h)
• ESC 0/1h: Guideline (Rapid rule-out/in)

Serial testing protocol

Repeat draws catch infarcts missed by a single early troponin.

A single early-negative troponin never excludes MI.