What tests help diagnose a resolved thrombosis?

Question

Hi doctor,

About two years ago, I went to the hospital where they noticed ST elevation, and I was immediately transferred to a larger hospital due to a suspected heart attack. During the angiography, my arteries turned out to be clear, but my troponin levels had spiked. My doctor suggested it could have been myocarditis or a resolved thrombosis (by the time I reached angiography) but did not request an MRI or further imaging.

The next day, my troponin level had almost halved, and I had no pain, so I was discharged. Since then, I have gone for follow-ups and seen probably more than ten cardiologists, yet no one can say for sure what happened or what lasting effects it might have. I am not on any medication. The last doctor I saw did not think it was myocarditis, but he was not entirely sure either.

Am I doomed? Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

From the information you have provided, it is just obvious that you do not have coronary artery disease since your angiography was normal. Further information is needed to reach an exact diagnosis. Based on the history you have provided, there could be several differential diagnoses for your problem.

Myocarditis is usually preceded by viral fever, and an echocardiogram in the majority of cases shows dysfunction. If it were a thrombus in your blood vessels, which was resolved by the time of angiography, your echocardiogram may show LV (left ventricular) dysfunction in the territory of the artery occluded by the thrombus, or it could just be normal. Your history is also explained by coronary artery spasm, which is very rare, and it is a diagnosis that will need further workup to confirm, including an angiogram and vasospastic challenge test.

Similarly, microvascular angina will also show normal coronary arteries on an angiogram, but it can be identified through coronary flow reserves, myocardial perfusion scans, and other tests. Cardiac MRI (magnetic resonance imaging) will also provide a great deal of information. However, your cardiologist must decide which test to perform, based on your clinical condition, echocardiogram findings, and risk factors. You should consult your cardiologist regarding which medication you should be on and if you need any further tests.

I hope this information helps you.

Revert in case of queries.