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What causes pain in back radiating to chest?

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Posted on Mon, 16 May 2016
Question: I woke up this morning with left back pain that was slightly moving to my chest. I went to the Er and My troponin was measured at 0.00 at one measurement and 0.01 a few hours later. Should i be concerned?
doctor
Answered by Dr. Ilir Sharka (28 minutes later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I would explain that level of 0.01 is the upper limit of normal values of troponin.

But, even there is an insignificant raise in the troponin levels, this lab finding should be coupled with the resting ECG changes during this episode, in order to conclude about any possible myocardial ischemia. You should know that troponin is an enzyme which can be found in other cells, besides cardiac cells. That is why lab finding should be correlated with ECG findings.

Could you please upload your resting ECG performed at the ER for me to review and give another professional opinion?

A cardiac stress test would be the test of choice to detect possible myocardial ischemia.

A cardiac ultrasound would be necessary to examine your cardiac structure and function.

Hope to have been helpful!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka (2 minutes later)
Would it be nornal for troponin to vary that much in 2 hours?
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello again!

I would explain that this is not a significant raise in troponin values.

But, I would recommend repeating troponin levels every two hours in the next hours, in order to exclude possible myocardial ischemia.

Further increase in troponin levels would be concerning.

Hope to have been helpful!

Greetings!

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (1 hour later)
Should they change at all from one measuremenr to another?
doctor
Answered by Dr. Ilir Sharka (44 minutes later)
Brief Answer:
Opinion as follows:

Detailed Answer:
Hello again,

I would explain that such a variation in Troponin level is not clinically significant.

Slight variations within normal ranges is not rarely found in healthy individuals; but what should not be present is the increasing level trend of Troponin when the clinical symptomatology is suspicious.

As I explained you above, the best strategy for concluding about possible causes of this slight variation is to continue checking Troponin for the next couple of hours (every two hours).

If no any further rise is detected, then nothing to worry about.

But, if it continues to rise again, then a careful differential diagnosis is necessary to find the exact reason.

In order to further investigate for any cardiac reason, additional imagine tests, like cardiac ultrasound, coronary angio CT would be a rationale option, especially if you have coronary risk factors (hypertension, dyslipidemia, smoking, glucose metabolism disorder or diabetes, heredity for CAD).

But, you should also know that an abnormal Troponin rise may be cause by several extra-cardiac reasons, like disease of the aorta, pneumonia, pancreatitis, after strenuous physical exertion, systemic inflammation/sepsis, chest trauma, pericarditis, myocarditis, rhabdomyolysis etc.

That’s why it is necessary to measure serial Troponin levels and also correlate those lab values with the clinical symptomatology.

So, to conclude, I would like to assure you that the actual Troponin variations are not concerning.

But, if you want to put your mind completely at rest, you need to check Troponin levels also for a couple of hours.

Hope to have been helpful.

Regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (1 hour later)
Another sample was pulled 6 hours later and was back at 0. Thank you .
doctor
Answered by Dr. Ilir Sharka (22 minutes later)
Brief Answer:
You are welcome!

Detailed Answer:

So, nothing to worry about!

Your Troponin level has remained normal all the time.

As a conclusion, cardiac ischemia is not an issue to be considered.

Wishing you good health!

Feel free to ask me again whenever you need!

Regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (11 minutes later)
I have one more question. My ECG from todays says RSr' in V2 and it is slightly different than an old ecg I had done previously. Is this normal? The first attachment is my original ECg and the second is from today .
doctor
Answered by Dr. Ilir Sharka (11 minutes later)
Brief Answer:
Nothing to worry about!

Detailed Answer:
I could explain that your previous ECG recording shows some baseline oscillations (not optimal registration), so it’s difficult to confirm or exclude a r’ in V2.

I would like to explain you that no any significant difference exists between those two ECG, and what is more important is judging the ECG as a whole and not a single lead.

To conclude, I would say that no any abnormality is confirmed by those ECG strips.

So, relax and don’t worry!

You may upload the entire ECGs for a comprehensive review.

Greetings!

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (4 minutes later)
I added them. Thank you .
doctor
Answered by Dr. Ilir Sharka (10 minutes later)
Brief Answer:
Your ECGs are fine!

Detailed Answer:
Hi,

Your ECGs are almost the same, just a more prominent J point in the last ECG.

No presence of arrhythmia, atrio-ventricular conductance disturbances, no specific repolarization abnormalities.

So, you shouldn’t worry about them!

Just relax and enjoy your day!

Regards,

Dr. iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (5 minutes later)
Okay. I really appreciate you. :)
doctor
Answered by Dr. Ilir Sharka (2 minutes later)
Brief Answer:
You are welcome!

Detailed Answer:

I remain at your disposal in case of any furhter uncertainties.

You can ask me directly if you meed.

Best wishes,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Ilir Sharka

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What causes pain in back radiating to chest?

Brief Answer: I would explain as follows: Detailed Answer: Hello! Welcome and thank you for asking on HCM! I would explain that level of 0.01 is the upper limit of normal values of troponin. But, even there is an insignificant raise in the troponin levels, this lab finding should be coupled with the resting ECG changes during this episode, in order to conclude about any possible myocardial ischemia. You should know that troponin is an enzyme which can be found in other cells, besides cardiac cells. That is why lab finding should be correlated with ECG findings. Could you please upload your resting ECG performed at the ER for me to review and give another professional opinion? A cardiac stress test would be the test of choice to detect possible myocardial ischemia. A cardiac ultrasound would be necessary to examine your cardiac structure and function. Hope to have been helpful! Kind regards, Dr. Iliri