Skeletal Muscle Disease as Noncardiac Cause of Cardiac Troponin T Elevation

Sribhen, Kosit; Phankingthongkum, Rewat; Wannasilp, Nilrat

doi:10.1016/j.jacc.2011.11.052

Cited by 10 publications

(7 citation statements)

References 2 publications

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“…It has been suggested that cTnT elevations detected during rhabdomyolysis may be the result of reexpression of a specific isoform seen in regenerating skeletal muscle, as this condition is characterized by simultaneous degradation and regeneration of skeletal muscle [ 10 ]. The elevated cTnT levels in this case could therefore be due to regeneration of skeletal muscle tissue and not myocardial damage, which was also reflected in the increasing cTnT-levels despite decreasing levels of CK and myoglobin and particularly the increasing CK-MB/CK ratio [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Drug-Induced Rhabdomyolysis with Elevated Cardiac Troponin T

Egholm

Pareek

2015

Case Reports in Medicine

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The essential role of cardiac troponin in the diagnosis of acute myocardial infarction has led to the development of high-sensitivity assays, which are able to detect very small amounts of myocardial necrosis. The high-sensitivity cardiac troponin T assay, however, is not entirely specific for myocardial injury. This case report describes a 48-year-old woman, who, two years after cardiac transplantation, presented with rhabdomyolysis. During the course of the disease, her troponin T level was elevated on repeated occasions, but other definitive evidence of myocardial injury was not found. Asymptomatic cardiac troponin T elevations during rhabdomyolysis may be due to either cardiac involvement or false positive results stemming from skeletal muscle injury.

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Section: Discussionmentioning

confidence: 99%

Drug-Induced Rhabdomyolysis with Elevated Cardiac Troponin T

Egholm

Pareek

2015

Case Reports in Medicine

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“…A case report of a 27 year old man with rhabdomyolysis secondary to amphetamine use and incarcerated hernia demonstrated two elevations of troponin levels: 3 days and 9 days post-operatively, with maximum on post-operative day 18 [35]. The authors attributed this peak in cTnT and not cTnI on day 9 as possible re-expression of cTnT, an isoform during skeletal muscle regeneration [35,36]. However, the mechanism of troponin rise in rhabdomyolysis, remains poorly understood and debated [35,37].…”

Section: Rhabdomyolysismentioning

confidence: 99%

“…The authors attributed this peak in cTnT and not cTnI on day 9 as possible re-expression of cTnT, an isoform during skeletal muscle regeneration [35,36]. However, the mechanism of troponin rise in rhabdomyolysis, remains poorly understood and debated [35,37]. As demonstrated in the literature, troponin elevation is common among patients with rhabdomyolysis and may portend poor patient outcomes [32][33][34].…”

Section: Rhabdomyolysismentioning

confidence: 99%

A Review of Cardiac and Non-Cardiac Causes of Troponin Elevation and Clinical Relevance Part II: Non Cardiac Causes

Akwe

Halford

Kim

et al. 2018

JCCR

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Non-cardiac causes of elevated troponins are often overlooked, yet elevated troponins have been shown to closely correlate with the prognosis of these conditions. The clinical significance of elevated troponins in non-cardiac conditions are not completely known. Also, it is still unclear if these clinical conditions need to be managed differently when they lead to an increase in troponin levels. Some of the non-cardiac conditions in which elevated troponins are commonly found include: pulmonary embolism, end stage renal disease, Sepsis/ Systemic inflammatory response syndrome (SIRS) and critically ill patient, rhabdomyolysis, physical exercise, burns, drug toxicity and stroke. This article discusses the suggested etiology of elevated cardiac troponins in these conditions and the prognostic values they carry.

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“…Clinicians need to keep this in mind when evaluating patients for cardiovascular disease who may have underlying skeletal myopathy, albeit subtle, especially when their clinical presentations are atypical and where increases of cTnT seem to stand alone indicating cardiovascular involvement . Some authors have thought that the re‐elevations of TnT levels in the subacute phase of rhabdomyolysis relate to the re‐expression of TnT isoform during the regeneration of skeletal muscle . This expression is perhaps triggered by inflammatory changes or severe damage occurring within the skeletal muscle .…”

mentioning

confidence: 99%

“…Some authors have thought that the re‐elevations of TnT levels in the subacute phase of rhabdomyolysis relate to the re‐expression of TnT isoform during the regeneration of skeletal muscle . This expression is perhaps triggered by inflammatory changes or severe damage occurring within the skeletal muscle . There has, to date, been no report on the specific effect of rhabdomyolysis on cardiac muscle and the function of cardiac muscle.…”

mentioning

confidence: 99%

Rhabdomyolysis in association with simvastatin and dosage increment in clarithromycin

Page

Yee

2014

Internal Medicine Journal

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Clarithromycin is the most documented cytochrome P450 3A4 (CYP3A4) inhibitor to cause an adverse interaction with simvastatin. This particular case is of interest as rhabdomyolysis only occurred after an increase in the dose of clarithromycin. The patient developed raised cardiac biomarkers without any obvious cardiac issues, a phenomenon that has been linked to rhabdomyolysis previously. To date, there has been no reported effect of rhabdomyolysis on the structure and function of cardiac muscle. Clinicians need to be aware of prescribing concomitant medications that increase the risk of myopathy or inhibit the CYP3A4 enzyme. Our case suggests that troponin elevation could be associated with statin induced rhabdomyolysis, which may warrant further studies.

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Skeletal Muscle Disease as Noncardiac Cause of Cardiac Troponin T Elevation

Cited by 10 publications

References 2 publications

Drug-Induced Rhabdomyolysis with Elevated Cardiac Troponin T

Drug-Induced Rhabdomyolysis with Elevated Cardiac Troponin T

A Review of Cardiac and Non-Cardiac Causes of Troponin Elevation and Clinical Relevance Part II: Non Cardiac Causes

Rhabdomyolysis in association with simvastatin and dosage increment in clarithromycin

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