Heart has three layers
Epicardium is same as visceral pericardium . If pericardial inflammation dissusely occurs , it is bound to injure the epicardium and subepicardium .
Does the troponins located deep inside the myocardium ?
No .It can even be present just few microns below the visceral pericardium . Hence severe forms of pericarditis can elevate the troponin levels without any issues .
Is troponin release related to ST elevation ?
Ideally most forms of pericarditis can be termed as epicarditis. The mechanism of ST elvation in pericarditis is actually a sign of epicardial injury.In fact , there is no easy way to differentiate a slice of epicardial infarct from an inflammatory pericarditis accurately .
Is there any form of pericarditis which invlove only parietal pericardium ?
We do not know as yet , about existance of such an entity. It is distinctly possible. However , if present it is unlikely to result in significant ST elevation in ECG.
In pericarditis , troponin release is due to inflammation or necrosis ?
Both are possible .Even transient wall motion defects are reported in isolated pericarditis.
What is myopericarditis ?
It is a general term used to indicate the above situation . In practical terms Pericarditis + Troponin positivity can be termed as myopericardits. It is well known pericardits can extend to endo- myocardium but it is rare other way around( ie endocarditis extending to pericardium )
What is pancarditis ?
It is the carditis involving all three layers of heart ,Cassically occura in rheumatic fever. Fulminant carditis is known to raise the troponin to significant levels.
Does troponin elevation in pericarditis occur in all ?
We are yet to collect adequate data about this . Diffuse , extensive pericarditis ,gross ST elevation , and associated pericardial effusion correlate with troponin.
Crazy questions in pericardiology
What is the pericardial blood supply ? Is there an entity called ischemic pericarditis ?
Do not ever underestimate the importance of pericardium whenever you encounter unexplained ST elevation in ECG.
Here is an article which has meticulously studied this issue