Cardiac troponin I in pre‐eclampsia and gestational hypertension

Fleming, S; O'Gorman, T; Finn, Joseph D.; Grimes, H.; Daly, Kieran; Morrison, John J.

doi:10.1111/j.1471-0528.2000.tb11658.x

Cited by 332 publications

(53 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The normotensive group were non-proteinuric patients with uncomplicated pregnancies. The criteria for pre eclampsia were as follows: at least two separate blood pressure readings O 140/90 mmHg, and the presence of C1 protein or more, by dipstick analysis on more than one occasion (Fleming et al 2000). Women with known pre existing cardiac or renal disease were excluded from the study.…”

Section: Tissue Collectionmentioning

confidence: 99%

Rho A/Rho kinase: human umbilical artery mRNA expression in normal and pre eclamptic pregnancies and functional role in isoprostane-induced vasoconstriction

Friel¹,

Sexton²,

O’Reilly³

et al. 2006

Reproduction

View full text Add to dashboard Cite

Pre eclampsia represents a state of increased or prolonged vasoconstriction, partially linked to the potent vasocontractile effect of isoprostanes. The process of Rho A-mediated calcium sensitisation is inherent to a state of prolonged contractility in many smooth muscle types. The aim of this study was (1) to investigate mRNA expression levels of Rho A and Rho kinase isoforms (I and II) in the umbilical artery from normotensive and pre eclamptic women and (2) to determine whether the effects of two isoprostanes, 8-iso prostaglandin F 2a (8-iso PGF2a) and 8-iso prostaglandin E 2 (8-iso PGE 2 ), on umbilical artery tone, were mediated via the Rho kinase pathway. Real-time RT-PCR using primers for Rho A, ROCK I and ROCK II was performed on total RNA isolated from umbilical artery specimens obtained from normotensive and pre eclamptic women. The effects of both isoprostanes (nZ6) (in the absence and presence of the specific Rho kinase inhibitor Y-27632), on umbilical artery tone were measured, and compared with control recordings. Rho A mRNA expression levels were significantly lower in umbilical artery samples obtained from pre eclamptic women (nZ4) in comparison to those from normotensive women (nZ6) (P!0.05). ROCK I and ROCK II mRNA levels were similar in both vessel types (PO0.05). Both isoprostanes exerted a significant concentration-dependent vasocontractile effect (nZ7) (P!0.001) on umbilical artery. For 8-iso PGE 2 , this effect was antagonised by Y-27632 (nZ6) (P!0.01). The significant reduction of Rho A mRNA levels in umbilical arteries from pregnancies complicated by pre eclampsia may serve to counteract the diminished perfusion associated with the pathophysiology of pre eclampsia. The vasocontractile effect of 8-iso PGE 2 in pre eclampsia may in part be mediated via the Rho kinase pathway.

show abstract

Section: Tissue Collectionmentioning

confidence: 99%

Rho A/Rho kinase: human umbilical artery mRNA expression in normal and pre eclamptic pregnancies and functional role in isoprostane-induced vasoconstriction

Friel¹,

Sexton²,

O’Reilly³

et al. 2006

Reproduction

View full text Add to dashboard Cite

show abstract

“…Cong et al have reported that cardiac remodeling occurs in patients with preeclampsia, and is associated with eccentric myocardial hypertrophy, with reduced EF [18]. Indeed, cTnI values measured during gestational hypertension and preeclampsia show higher values in the latter [7]. But it is also evident that not all patients with preeclampsia demonstrate a significant rise in cTnI or whether cTnI levels increase during the course of the disease and are affected by the increasing severity of the disease [16,19].…”

Section: Discussionmentioning

confidence: 95%

“…Lastly, elevation of cTnI in hypertensive disorders of pregnancy is well reported, although the cause remains unclear [7,[12][13][14][15]. Fleming et al demonstrated five-fold higher values of cTnI in preeclamptic women than in normotensive pregnant women, indicating possible subclinical cardiac myofibrillatory damage.…”

Section: Discussionmentioning

confidence: 99%

“…CK-MB is synthesized in the uterus and placenta and this may be detected in significant amounts in healthy pregnant women, and is therefore a poor marker for diagnosing myocardial damage [6]. CTnI therefore remains the most sensitive and specific marker for myocardial damage in the presence of ischemic or non-ischemic myocardial injury, including during pregnancy [7,8].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Interpretation of Cardiac Enzymes in Hypertensive Disorders of Pregnancy: Seeking Diagnostic Clarity

Mathur

2017

J Med Cases

View full text Add to dashboard Cite

A markedly raised cardiac troponin I (cTnI) in a patient is always alarming and usually suggests significant myocardial damage, as seen in acute myocardial infarction. There are, however, other circumstances where raised cTnI may be encountered without overt myocardial necrosis. Prior studies have evaluated serum cTnI levels in preeclampsia, eclampsia and normotensive healthy pregnant women in order to define their diagnostic value. Other factors, such as altered renal function, as in preeclampsia, may also affect the serum troponin levels, leading to misdiagnosis and incorrect management. We highlight the diagnostic and management difficulties faced in the management of our patient who presented with raised cTnI following multiple eclamptic fits, without other signs of an acute cardiac event.

show abstract

“…6 Troponin levels have also been studied during pregnancy and are generally felt to remain in the normal range, but they may rise to the upper limit of normal. 7,8 Like BNP, troponin levels are higher in women with hypertensive disorders of pregnancy, particularly pre-eclampsia.…”

Section: Information About a Real Patient Is Presented In Stages (Bolmentioning

confidence: 99%

Caesarian Dissection

et al. 2013

View full text Add to dashboard Cite

Forward Information about a real patient is presented in stages (boldface type) to an expert clinician (Dr Nandita S. Scott), who responds to the information, sharing her reasoning with the reader (regular type). A discussion by the authors follows.A 35-year-old woman, G2P1, with a history of Hashimoto's thyroiditis, vitiligo, and gestational diabetes mellitus presented in the 30th week of pregnancy with premature labor. She was admitted to the obstetrics service for monitoring and tocolytic therapy. On hospital day 2, the patient complained of chest heaviness and left arm discomfort, but her assessment was confounded by pain secondary to frequent uterine contractions. On hospital day 3, fetal monitoring disclosed a nonreassuring fetal heart rate pattern, prompting transfer to the operating room for urgent Caesarian section. A viable female infant was delivered, but the immediate postoperative course was complicated by acute dyspnea, coughing, and hypoxia.Dr Nandita S. Scott: Dyspnea is quite common during pregnancy as a result of physiological changes including weight gain, dilutional anemia of pregnancy, and progesterone-induced hyperventilation. This can make the distinction between pathology and normal dyspnea of pregnancy difficult. In contrast, hypoxia during pregnancy is never normal. The cardiac causes of hypoxia in the peripartum period can be broadly separated into 2 categories: congestive heart failure from preexisting cardiac conditions (eg, cardiomyopathy, valvular disease, or congenital heart disease) or congestive heart failure attributable to pregnancy-induced cardiac conditions (eg, peripartum cardiomyopathy or acute ischemic events). Pulmonary causes such as pulmonary embolism and amniotic fluid embolism also need to be considered.Pregnancy poses a large hemodynamic burden on the cardiovascular system. A 30% to 50% rise in blood volume and cardiac output, increase in heart rate, reduction in systemic vascular resistance resulting from the low-resistance placental unit, physiological anemia, and positional reduction in cardiac output attributable to compression of the inferior vena cava all contribute to stress the heart. 1 Pregnancy may therefore unmask a preexisting cardiac condition that was unknown before conception. At delivery, this hemodynamic burden increases further as a result of the autotranfusion of uteroplacental blood, tachycardia from pain, and the loss of the low-resistance placental unit. Consequently, the cardiovascular adaptations of pregnancy remain clinically relevant after delivery of the fetus. Indeed, it may be months before the circulation fully returns to normal.This patient had no preexisting cardiac conditions that we are aware of. On hospital day 2 she developed chest pain, which suggests a possible ischemic cause for her symptoms. Peripartum cardiomyopathy is a less likely explanation for her symptoms, because this patient was only 30 weeks pregnant and peripartum cardiomyopathy occurs most often in the last month of pregnancy and the first 5 months after delivery.I...

show abstract

Cardiac troponin I in pre‐eclampsia and gestational hypertension

Cited by 332 publications

References 20 publications

Rho A/Rho kinase: human umbilical artery mRNA expression in normal and pre eclamptic pregnancies and functional role in isoprostane-induced vasoconstriction

Rho A/Rho kinase: human umbilical artery mRNA expression in normal and pre eclamptic pregnancies and functional role in isoprostane-induced vasoconstriction

Interpretation of Cardiac Enzymes in Hypertensive Disorders of Pregnancy: Seeking Diagnostic Clarity

Caesarian Dissection

Contact Info

Product

Resources

About