Elevated Troponin Levels after Prolonged Supraventricular Tachycardia in Patient with Normal Coronary Angiography

Abstract

The European Society of Cardiology and the American College of Cardiology redefined the concept of myocardial infarction in the presence of highly positive markers of myocardial injury associated with at least one of the following: ischemic symptoms; development of pathologic Q waves on the ECG or ECG changes indicative of ischemia (positive or negative deviation of the ST segment), making troponins one of the most important aspects in the evaluation and stratification of patients with chest pain in the emergency room. However, although troponin gives excellent accuracy in the identification of myocardial necrosis, it is known that it can also be elevated in a series of nonatherosclerotic heart diseases. We present the case of a 49-year-old female patient admitted to the Chest Pain Unit with a history of supraventricular tachycardia associated with chest discomfort, nausea and diaphoresis. During risk stratification, the patient presented with a high serum troponin T level (0.143 ng/ml) but with a normal coronary angiography.

Troponin utilization in patients presenting with atrial fibrillation/flutter to the emergency department: retrospective chart review

“…In our study, 79% of patients with a positive troponin had a potential alternative diagnosis for a rise in troponin other than ACS, corroborating findings from other studies [13]. Demand-related rise in troponin could account for 35.7% of cases, as has been seen in numerous other studies [14-17]. In a study of patients presenting with elevated TnI levels with subsequent normal coronary angiogram, tachyarrythmias were the cause of TnI release in 28% of cases [18].…”

Elevated Serum Cardiac Troponin I in Cattle with Theileriosis

“…It may be speculated that increased oxygen consumption by the myocardium during a prolonged period of tachycardia is combined with a reduced oxygen supply to the myocardium because of the shortened diastole during tachycardia . There are few published reports on human patients with high troponin levels secondary to supraventricular arrhythmias . There is no case of supraventricular tachycardia in this study, but sinus tachycardia were diagnosed in 68.8% of infected cattle.…”

“…The changes in myocyte membrane permeability resulting from the injury could be enough for the release of cardiac troponins from the free cytosolic pool of myocytes without structural damage . The exact mechanism of myocardial injury in an apparently normal heart is unclear . It may be speculated that increased oxygen consumption by the myocardium during a prolonged period of tachycardia is combined with a reduced oxygen supply to the myocardium because of the shortened diastole during tachycardia .…”

“…The exact mechanism of myocardial injury in an apparently normal heart is unclear . It may be speculated that increased oxygen consumption by the myocardium during a prolonged period of tachycardia is combined with a reduced oxygen supply to the myocardium because of the shortened diastole during tachycardia . There are few published reports on human patients with high troponin levels secondary to supraventricular arrhythmias .…”

Elevated high-sensitivity troponin does not indicate the presence of coronary artery disease in patients presenting with supraventricular tachycardia

“…In patients with SVT, elevated Tn-levels may be observed [5] but case reports and small case series indicate that elevated Tn in patients with SVT does not necessarily indicate the presence of CAD [10][11][12].…”