Previous studies have identified a significant incidence of clinically unrecognised myocardial ischaemia in intensive care unit (ICU) patients, as determined by elevation of serum troponin. This pilot study demonstrates a similar high frequency of such a phenomenon in patients who are acutely ill, but without clinical evidence of myocardial ischaemia, on the general medical wards of a large city hospital. Elevation of serum troponin in these patients is associated with higher hospital mortality and increased lengths of hospital stay. Recognition that slight elevation of troponin levels may occur in the context of significant medical illness in acute general medical ward patients is important as it may avoid erroneous diagnosis of myocardial infarction and subsequent unnecessary investigations. A literature review of the various causes of an elevated troponin result is then presented.