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Suggest treatment for severe flank pain and elevated troponin levels

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Posted on Wed, 26 Oct 2016
Question: yes thank you...55 yo male with a hx of cardiac endarterectomy, in the hospital now c/o of chest pains, hgb is 7. had an egd/colonoscopy which were negative, ct abdomen showed nothing, now is pale with sob and severe flank pain,,,,any ideas?
otherwise hx male, does not smoke, social drinker...both parents died from heart issues/cancer, younger brother with ca.
has not received a transfusion yet..thankyou

additionally, troponin was elevated, nothing of note on ekg regarding an MI, cardiac enzymes were elevated
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Answered by Dr. Rishi (2 hours later)
Brief Answer:
It seems like a Heart attack or cardiac tamponade.

Detailed Answer:
Hello,
I am a Vascular Surgeon and will try to help you.
Firstly, could you give me some details of what surgery was done - As you mention Cardiac endarterectomy. Could you tell me as to what was the problem he was having at that time and what was done and how long back? That would help me to diagnose the condition.
Present problem of chest pain with raised enzyme levels point towards Cardiac ischemia or a heart attack. He should be managed by a Cardiologist and would probably require a Coronary Angiography to know whether all coronary arteries are flowing well. If there are any blocks then they should be dealt with in the same sitting with Stenting or Ballooning.
Another possibility is Cardiac tamponade due to bleeding but that would be commented upon better if I know the history of the surgery done earlier and the report of the Echo done in this admission.
Please do let me know.
Take care and I will await your response.
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Rishi

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Suggest treatment for severe flank pain and elevated troponin levels

Brief Answer: It seems like a Heart attack or cardiac tamponade. Detailed Answer: Hello, I am a Vascular Surgeon and will try to help you. Firstly, could you give me some details of what surgery was done - As you mention Cardiac endarterectomy. Could you tell me as to what was the problem he was having at that time and what was done and how long back? That would help me to diagnose the condition. Present problem of chest pain with raised enzyme levels point towards Cardiac ischemia or a heart attack. He should be managed by a Cardiologist and would probably require a Coronary Angiography to know whether all coronary arteries are flowing well. If there are any blocks then they should be dealt with in the same sitting with Stenting or Ballooning. Another possibility is Cardiac tamponade due to bleeding but that would be commented upon better if I know the history of the surgery done earlier and the report of the Echo done in this admission. Please do let me know. Take care and I will await your response. Dr Rishi, New XXXXXXX XXXXXXX