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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

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What does raised troponin level indicate?

Answered by
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Dr. Vidya KR

General & Family Physician

Practicing since :2011

Answered : 1561 Questions

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Posted on Tue, 15 Apr 2014 in Hypertension and Heart Disease
Question: I'm a first timer here and would appreciate any assistance. I'm a 35 year old male, weighing 250lbs and 5'11 in height. I don't smoke, drink or use street drugs. A little history: I was hospitalized in 2012. I felt chest vibrations and was taken to the hospital. My troponin level was elevated and all other tests (ekg, x-rays, stress-echo, coronary angio) were negative. I was then hospitalized 4 weeks ago with chest pressure. My troponin was elevated again. I believe both times my troponin elevated to .159. In any case, four weeks ago they performed x-rays, ekg, and echocardiogram, all results were normal. I saw my primary physician two days later and my troponin level came back as normal. I just had a stress test performed last Wednesday and the cardiologist gave me results that concerned me. He then said that the hospital didn't perform the echo correctly. I was like......ok...... Before I post the results, is there any sickness that can cause an increase in measurements within a four week span? Did the cardiologist take different measurements than the hospital? Did the hospital really make an error? I heard cardiologist is top notch, but then the hospital is known for excellent heart care. I'm at a loss about what to think. I spoke to my doctor today and she didn't know why the results from four weeks ago differ from today. She submitted for an extra echocardiogram today. Test Results: Clinical and Hemodynamic Findings: Baseline HR of 66 bpm increased to to 166 bpm after 6 minutes 30 seconds. This corresponds with 89% of MPHR. Baseline BP of 117/78 increased to 160/80. No chest pain. Exercise was discontinued because of fatigue and dyspnea. Electrocardiograph Finding: Baseline ELG showed normal sinus rhythm with RSR prime patterns in leads V1 and V2. No ischemic changes or dysrthymia was seen. Echocardiographic Findings: Baseline echo showed moderate LA dilation of 4.6 cm, normal LV size of 4.2 cm, mild LVH, normal wall motion and EF of 60%. Diastolic function and RV motion is normal. Valves have normal appearance with mild MR and TR and estimated RV pressure of 35mmHg. Post stress images demonstrate normal response. Discussion: (1) Exam negative for ischemia (2) Fair exercise capacity (3) Moderate LA dilation with mild LVH. Normal LV size and EF of 65% (4) Normal appearance of valves with mild MR and TR and estimated RV pressure of 35mmHg.
doctor
Answered by Dr. Vidya KR 2 hours later
Brief Answer: changes are possible, embolism. Detailed Answer: Hi XXXX Thanks for using HCM. I went through your query and understood your concerns. Raised troponin level with normal test report including stress test shows pretty good condition of your heart at that time. Troponin level do raise in other conditions like kidney problem, severe exhaustion, pulmonary embolism etc... So its not specific to heart problem. Yes changes what you have mentioned is still possible, Cardiac problems are very unpredictable and can arise at any time. Heart blood vessels would have blocked now resulting in reduced blood supply to particular part of heart, affect its function. Blocking material, what we call it as embolus in our terms, would have raised from other part of body like leg. This is medical condition which is possible, With this i can't even rule out error from hospital side, could be possible, but usually not, as for any abnormal report or in a patient with symptoms they double check values. Hope i answered your query. Feel free to ask further related query. I will be glade to answer them. Wish you a good health. Regards
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Vidya KR 1 hour later
Why would my echocardiogram show normal four weeks ago and now my stress test shows different. I posted the stress-echo results above.
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Answered by Dr. Vidya KR 6 hours later
Brief Answer: Embolism in small vessels Detailed Answer: Hi, thanks for follow up query. ECHO is basically to see functioning heart, to directly see how it contracts, size of each part of heart. Stress test is basically to check for ability of heart pumping, which depends on its blood supply. Through blood supply gets energy to work. When our body's work increases like exercise, heart has to work more to pump more blood. Discontinuation of stress test due to Dysnea signifies, now there is reduced blood supply to heart, possibly block in small vessels of heart. As I have already mentioned embolus can arise at any time and block it. Some times small blocks do get cleared off from our own inbuilt capacity to fight against disease . You may get normal report after few days too, even this is also possible. Your can check for source of embolus by doing Doppler study of leg veins done. I hope answered your query. Feel free to ask further related query. Wish you a good health Refards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Vidya KR 1 hour later
Here is what I'm trying to ask. Four weeks ago my left atrium was measured at 3.5 and last week it was measured at 4.6. Is there a sickness that would cause that? Is that a machine error? Did the person take the measurements different? How is that possible?
doctor
Answered by Dr. Vidya KR 24 hours later
Brief Answer: Technical problems Detailed Answer: Hi, thanks for follow up query. As valves are normal according to your ECHO report, sudden changes in size in left atrium is difficult to explain and no other findings to support also. Change in values could be due to different position of taking measurement. This is seen in many reports, what we call as interobserver variations in our terms. Different angulation of ECHO probe will show different size. Changes seen seem to be due to technical problems, Hope I answered your query. Wish you a good health. Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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