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    Can gastric problem lead to elevated troponin?

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Posted on Mon, 12 May 2014 in Heart Attack
Question: I am a female 57 year old, 5'10" and weigh 13stone 6lbs, at the time of the NSTEMI on XXXXXXX 14th I weighed 14stone 6lbs. I had been put on Levothyroxine a month beforehand in Dec 2013 when I had high TSH but low but normal thyroid. I was a bit stressed but nothing unusual. I am a Mum of teenagers, getting divorced and looking after my elderly Mum, so nothing unusual! Everything was fine then my son just generally felt ill during January and stayed off school for a few days the week before the NSTEMI. I had started belching, not just birping but belching a few weeks beforehand. Then I felt ill over the weekend and was sick just bringing up bile for a few days and stayed in bed. I remember ringing my friend feeling really down and in tears. But while I was actually being sick I remember feeling like a tearing in my neck at the front side, I thought at the time that it was unusual and I only brought up bile. 2 days later, after a really stressful day, I suddenly lifted a heavy shopping bag in front of me stretching forward unloading the car and suddenly got chest pain. I assumed I had pulled a muscle in my chest. It was late and I wanted to get home so drove home and when I got out of the car my back had a terrible ache, and my daughter called an ambulance. After being given aspirin and a GT spray it subsided but I spent 3 days in hospital. I was told I had had a heart attack and my troponin levels had risen to 2000. EKG was normal, I was put on Clopidogrel and aspirin and on day 3 I was finally given an angiogram after being left off the list for several days. Nothing was found, I had good clear arteries, cholesterol was 4.8. I was allowed home with a follow up at the end of April and an echocardiogram in April. In Feb I had an episode of terrible anxiety and palpitations during the night. An ambulance was called but they said everything was ok and I was reassured. I rang for an appointment with my doctor the next day and typical, I couldn't get an appointment but the duty doctor rang and gave me Diazepan. I was telephoned by my doctor a week later saying that I was started on 50mg Levothyroxine which was too high and I was put onto 25mg Levothyroxine. My palpitations stopped and most of my high anxiety and feelings of panic. I kept thinking I was having another heart attack. I have now finally had an echocardiogram and the operator said there was no abnormality and she couldn't believe that I had had a heart attack. No damage was found. Then I had a copy of a letter to my doctor from a different cardiologist saying I have a mild tricuspid valve regurgitation which is found in normal individuals. Nothing else. My follow up has been put forward to now the end of May. The nurses at rehab just say I am a mystery, but that doesn't help my worry. I have mild waves of panic sometimes but its difficult to tell if it is my heart, side effects of the drugs I am still taking or this Levothyroxine which is all linked. I have taken myself off these poisoning and dreadful statins and thank goodness all my terrible aches have gone. I just eat very well, stay off the cakes, biscuits and bad fats, have a 15 min fast walk in the evening and stay more active. I take plant sterols, magnesium, garlic and resveratrol. I have lost 1.5 stone and my belt is now at the tightest, yippee! But I still constantly worry about my heart. I just couldn't believe that I had a heart attack, unknown in my family, all lived to a ripe old age. So been thinking that what if the Troponin levels can rise without a heart attack? I just feel as though been brushed aside and filed in the 'Mystery' file. I don't like to have the label 'Heart Disease' or 'Heart Attack Victim'. I still belch ocassionally and I feel the need to clear my throat when talking, sometimes I go to talk and I don't have any voice then have to clear my throat before it comes back. This has been happening for years but the belching started Christmas time. I did eat quite a lot of chocolate over Christmas, a bit of comfort eating and my weight had been rising gradually. I wonder if my pains and troponin levels were caused by a gastric condition related to my sickness and feeling of tearing in my neck. I was sick Sat Sun and had the NSTEMI on Tuesday evening. I would like to find out the answer as it would stop all my worrying about my heart. I am now on Clopidogrel and Aspirin. I can walk fast for 15 mins with no pain and haven't had chest pains since.
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Answered by Dr. Benard Shehu 3 hours later
Brief Answer: Normal angiography,nothing to worry about... Detailed Answer: Hi, I have gone through your medical history carefully and understood your concerns. I have gone through your reports and can admit that might be a case of acute coronary syndrome associated with hypothyroidism. Your coronarography was normal, and no pathological evidence was present. With regards to troponin, it can be raised due to factors other than infarct; however, gastric problems do not cause its elevation. So, my opinion is that your clinical symptoms are partially related to levothyroxin and statin use. It is important to get your lipids back to normal through diet and lifestyle changes and to follow your doctor's advice on using levothyroxin in order to stabilize thyroid hormones. I also advise to do: - cardiac ECHO - stress test for further evaluation. At the end, as long as angiography was ok, there is nothing to be worried about. Hope it was of help! Let me know if you have further queries! Dr.Benard
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Benard Shehu

Cardiologist

Practicing since :2004

Answered : 2257 Questions

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