High Troponin-T in Acute Biliary Pancreatitis: Is it a Real Myocardial Injury?

Abstract

Acute pancreatitis (AP) is characterized by abdominal pain and elevated levels of pancreatic enzymes in the serum. Pain is the hallmark of this condition, and as a presenting symptom, is localized in the epigastrium in at least 60% of patients having the mild or severe form of the disease. Thus, the differential diagnosis may be difficult in some cases due in part to the fact that the disease may mimic other diseases, and in particular, acute coronary syndrome. We present the case of a patient who presented to our facility with epigastric pain, normal electrocardiogram (ECG), elevated high-sensitive troponin-T and elevated lipase, and amylase. Laboratory investigations and ultrasonography confirmed AP, with further serial ECGs being within the normal limits and normal echocardiography. The patient underwent laparoscopic cholecystectomy and intraoperative cholangiogram. Postoperative diagnosis confirmed biliary pancreatitis with chronic cholecystitis.

Elevated troponin level and nonspecific ST‐segment and T‐wave changes in a suspected acute pancreatitis patient, post‐SARS‐Cov‐2 infection: A case report

“…Cardiac infarction may result from pancreatitisrelated microvascular dysfunction. 3 Electrocardiogram changes and biomarkers of myocardial injury have been observed during AP in some studies. 10,11 The literature extensively documents transient electrocardiographic changes in individuals with acute pancreatitis.…”

“…There are several factors that cause troponin to rise, including tachycardia, tachycardia infusion, and tachycardia release; strenuous activity; autonomic nervous system imbalance; and conditions directly affecting membrane permeability. 3 , 4 …”

“…The primary cause of elevated troponin levels without acute coronary syndrome (acute or chronic) is myocyte necrosis, which results from a mismatch between oxygen supply and demand. There are several factors that cause troponin to rise, including tachycardia, tachycardia infusion, and tachycardia release; strenuous activity; autonomic nervous system imbalance; and conditions directly affecting membrane permeability 3,4 …”

“…There are several factors that cause troponin to rise, including tachycardia, tachycardia infusion, and tachycardia release; strenuous activity; autonomic nervous system imbalance; and conditions directly affecting membrane permeability. 3,4 In the COVIDPAN study, people with COVID-19 had more severe AP than those without. 5 There have been several reports of pancreatic involvement in COVID-19.…”

Atrial Fibrillation With Decompensated Heart Failure Complicated With Non-ST Elevation Myocardial Infarction

“…A typical confirmation is elevated troponin levels. It is also worth mentioning that troponin elevation indicates injury to the myocardial cells, which may be triggered by inflammation trauma, tachycardia, ischemia, strenuous exercise, release or infusion of catecholamines, renal failure, or imbalance in the autonomic nervous system [9].…”