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What causes elevated troponin levels?

Answered by
Dr.
Dr. Rajaram KG

Orthopaedic Surgeon

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Posted on Sat, 25 Oct 2014 in GERD
Question: I had an echocardiogram and a cardiac ct angiogram because my troponin T level was .44 back in May this year.
Six hours after the initial troponin blood test that showed .44 it dropped back down to below .10 so the hospital said I hadn't had a heart attack and my test results which I sent to you were normal and the echocardiogram was normal also.

I've read that because my troponin was slightly raised I have a high chance of mortality within 1-3 years! I'm so frightened! My own gp said he can't explain why my troponin was raised so no one is explaining anything to me! I've still got heart attack symptoms and I can't understand why I had slightly elevated troponins in my blood with no explanation! I did have an agoraphobic panic attack at the time I felt pain travel from my heart down my arm to my thumb like a lightning bolt and that's why I went to hospital and they kept me in due to the raised .44 level and gave me the ct angiogram and echocardiogram

Am I at risk of dying in the next 1-3 years because of that elevation in troponin?

Medical history is
I had laparoscopy surgery January 28th this year then collapsed from a severe infection on January 29th
I had another laparoscopy surgery a month before (April 25th) the raised bloods and I have two cysts on my stomach, a cyst on my bladder and a cyst on my right ovary

I Also have proctitis

I've had heart attack symptoms. ( intermittent central chest pain/aches/bilateral arm pains and aches/shortness of breath/palpatations/back ache and jaw pain) since end of March this year so six months

I'm also suffering from nausea, ibs, gastris (endoscopy diagnosed)and possible costochondoritis due to rib pain and intermittent pain when breathing and gtn spray helps ease the pain but not remove it
doctor
Answered by Dr. Rajaram KG 2 hours later
Brief Answer:
You need not be anxious

Detailed Answer:
Hi,

After going through the report attached and entire clinical history, I think the report of Troponin T was false positive. This means although the positive results suggest that you have AMI or ACS, in false positive cases.

Overestimation of the troponin level would occur, resulting in the finding of increased troponin level, despite having no AMI or ACS. This occurs in the following conditions-
Analytic interferences like fibrin clots, microparticles in sample, hetereophile and human anti-animal antibodies, rheumatoid factor etc.

Also interference by bilirubin, hemolysis, lipemia, elevated alkaline phosphatase activity, macro immunocomplex formation or a faulty analyser may show similar false positive result. An absolutely normal cardiac CT angio report almost rules out the presence of any atherosclerotic blockage of any important blood vessel of your heart.

The chest symptoms you are having intermittently may be due to some esophageal problem, particularly esophagitis and gastro-esophageal reflux or may be functional.

As you have been suffering from several functional problems, as mentioned by you in the last para, I feel they are manifestations of a single psychiatric illness. You should consult a local psychiatrist and I think cognitive behaviour therapy may help you a lot to find well-being.

Now, regarding your mortality, nobody knows when he or some other people would die. The mortality rates are measured, so that we the doctors can understand and explain a patient how severe or fatal a disease is. That does not mean that everybody having diseases with high risk of mortality in one year will die in 1 year. These are statistical calculations for our understanding and taking prognosis related decisions.

Secondly, your report seems to be false positive.

And thirdly, reports of more definitive tests are very good. So, there is no point in being so anxious regarding your higher chance of mortality. Rather, this anxiety and emotional stress would adversely affect your physical and mental health and increase the chance of your mortality.

I hope I have successfully answered your query. If you find it helpful, please close the thread and rate my answer.
Regards.
Dr. Kaushik Sarkar
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Rajaram KG 2 hours later
I've just had my blood tests results from bloods that were taken yesterday and my ESR is elevated could I have endocarditis?! Despite my scans being 'normal?'
doctor
Answered by Dr. Rajaram KG 2 hours later
Brief Answer:
Endocarditis has been excluded

Detailed Answer:
Hi, as I had said earlier, you don't have any heart problem. Endocarditis has been excluded by echocardiography. You don't need to be panicked at all regarding heart problem. ESR may remain high in IBS patients in case they have small intestinal bacterial overgrowth.
You can have probiotic like Enterogermina oral suspension one such twice daily for 15 days.
For any further information, please write back. If you are satisfied with the answer, please close the thread and rate my answer.
Regards.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Rajaram KG 45 minutes later
The thing is I had the echo done in May but three weeks ago I had my wisdom tooth removed (upper right) and my muscle and joint pain, sweating and increased heart rate has got very severe since then my last esr test in XXXXXXX was normal but the one yesterday was elevated

I know dental surgery is a risk factor for bacteria to get into the blood stream
Do you think I need to go to my gp ASAP and tell them my concerns?

because it seems quite frightening I've had the dental surgery and now my symptoms are worse and my esr is raised

What else can raise ESR blood results?
doctor
Answered by Dr. Rajaram KG 4 hours later
Brief Answer:
Post surgical rise or infection

Detailed Answer:
Hi, thanks for posting the information.
However, I should tell you that ESR can rise after any physical stress, e.g. Surgery, infection etc. A raised ESR doesn't necessarily mean that you have endocarditis. It may have increased post surgery or there may be dental infection. A complete blood count would help diagnose a systemic infection. I still think that the cardiac symptoms are functional because of increased apprehension after surgery.
If you still want to be absolutely sure, you can have repeat echocardiography.
But, I think if your white cell count is raised alongwith increased absolute neutrophil count, then only there would be suspicion of infection. To find out whether that has spread to the heart you can then have echocardiography.
Another issue is, after dental surgery patient is usually advised to have antibiotic and if that is also the same in your case, there is very little chance of having any serious infection.
Therefore, please stop thinking about endocarditis and please consult a local psychiatrist..For any further information, please write back to me directly.
Regards
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Rajaram KG 47 minutes later
My FBC and CRT is it? (Respotory) and liver and kidney and thyroid tests all came back normal it was only my ESR that came back elevated

No I wasn't given any antibiotics

I'm quite fearful right now I have pain in my left breast and left chest area and my left arm is very heavy and pain in my ribs and left jaw and palpitations I believe it is a panic attack from my anxiety over this blood test I'm not hyperventilating but I'm very scared I've tried breathing exercising but it's not working do you think it's my anxiety?

Do you have any advice on how I can calm down from such severe anxiety?

doctor
Answered by Dr. Rajaram KG 5 hours later
Brief Answer:
CBT needed

Detailed Answer:
Hi, if your tests results are normal except for ESR, why are you anxious? That supports my previous diagnosis that this is the post surgical rise in ESR.
Severe form of generalised anxiety disorder, along with frequent panick attacks is what you are suffering from and this has engulfed your entire thought process resulting display of several components of primary cognitive error. Automatic thoughts are unhealthy because of your intermediate and core belief. These can only be corrected by Cognitive Behaviour Therapy. You can take appointment of your local CBT specialist. Usually it takes 8-12 sessions to help you out of the problems. If not available in your city, you can have my appointment. But, then you will have to fly all the way to XXXXXXX or have to arrange for some video session, but the latter setting is not ideal.
If you find this answer helpful, please close the thread and rate my answer.
Regards.
Dr Kaushik Sarkar

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Rajaram KG 14 hours later
I'm anxious because my mothers sister had every test possible including traditional Angio and she was told she had anxiety then two weeks later after each and every single one of her organs shut down her autopsy revelead endocarditis

I lost my auntie when she was cleared and told her heart was very healthy and she was suffer panic and anxiety when she had a fatal infection that's my worry.

I've developed petechia on my left hand / wrist, with a high esr test along with petechia it looks likely I do have endocarditis or meningitis I've added some photos of the petechia that developed sometime today should I go to Emergancy room?
doctor
Answered by Dr. Rajaram KG 9 hours later
Brief Answer:
Rashes needs evaluation

Detailed Answer:
I can understand why you are so apprehensive regarding the symptoms and test results and also sorry to hear the unfortunate event.
Now, as you've got rashes, you definitely need to visit the ER of nearest hospital for further evaluation.
But, development of rashes doesn't mean you have meningitis or endocarditis. Meningitis doesn't usually present only with rash. There will be neck rigidity, fever etc. And endocarditis has completely different dermatological signs.
But, rashes definitely warrant further investigations to rule out viral infection, platelet abnormality, vascularity etc. So, please visit the ER of nearest hospital at the earliest.
Regards
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Rajaram KG 36 hours later
My esr level was 18 and I went to my dr yesterday who said it was an allergic reaction and that my ct Angio scan in XXXXXXX ruled out endocarditis but I'm wary

The rash on my hand has disappeared and a few more appeared in a line on my bicep area but they have faded and almost vanished too

I'm sure it's petechia because I'm not allergic to anything. Could I have contracted endocartitis from the time between my ct Angio in XXXXXXX and now ?
doctor
Answered by Dr. Rajaram KG 3 hours later
Brief Answer:
Follow your doctor's advice

Detailed Answer:
Hi, thanks for consulting your local doctor.
I think your doctor must have clinically examined you and then diagnosed the condition as allergic reaction. Actually, we don't know what we are allergic too. There are numerous external objects or antigens to which we can be allergic. Allergy is only an abnormally exaggerated immune response. They can really be differentiated from petechial rashes by clinical examination and you need to believe in what your doctor tells you after examining you.
Allergic rashes usually fade away after the event of exaggerated immune response is over because of cessation of exposure to that specific allergen. You may have serum Ig E test done and also you can check what allergies you have by consulting the local allergy clinic. Simple blood test can detect the allergens and you need to avoid them. You can apply Calamine lotion over the rahses.
However, the most important thing is that you need to come out of the fear of having endocarditis. If that fear is engulfing you and you are still not contained with the fact, you need to consult a local psychiatrist. Otherwise, you will end up doing unnecessary tests repeatedly and will always have the fear of having endocarditis or some other serious illness.
You can actually develop endocardititis at any point of time. But, there are certain clinical features which are used to diagnose that coupled with certain investigations. When there is no clinical suspicion you need not have the fear of having that disease and do the tests repeatedly.
Please avoid unnecessary stress. If you are not able to do that yourself, you need to take help of a psychiatrist.
If you are satisfied with the answer, please close the thread and rate my answer.
Regards.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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