Cardiac troponins (cTn) are frequently assessed in patients presenting at the emergency department (ED) with chest pain and various diseases in which myocardial injury may be involved. Cardiac troponins are no longer only used for diagnostic investigations in acute coronary syndrome but may also provide valuable information regarding screening, prognosis, and risk stratification and help to guide therapeutic planning and ED dispositioning of patients with many different types of critical illnesses. Elevation of cTn is usually related to myocardial damage but is not synonymous with acute coronary syndrome. Other etiologies should be considered in the differential diagnosis of a patient presenting with atypical symptoms and elevated cTn, as accurate diagnosis will affect both the initial treatment as well as the initial triage. A thorough knowledge of how to interpret the implications of elevated cTn will allow ED physicians to expand their list of differential diagnoses, facilitate risk stratification and ED disposition, and avoid potential iatrogenic complications resulting from inappropriate interventional therapies.