Does a rise in troponin levels increase mortality risk?

Question

Hi doctor,

Six months ago, I had an echocardiogram and a CT (computed tomography) angiogram. My initial troponin T level was 0.44 ng/mL, but after six hours, it dropped to below 0.10 ng/mL. The results of the CT angiogram were normal, and my calcium level was 0 mg/dL. My echocardiogram was also normal. I wore a monitor for seven days, and the results were normal as well. I have read that an elevated troponin level can indicate a higher risk of mortality within one to three years, but my general practitioner could not explain why my troponin was raised.

I did experience a panic attack related to agoraphobia, during which I felt pain radiating from my heart down my arm to my thumb, like a lightning bolt. This prompted my visit to the hospital, where I was admitted due to an elevated troponin level of 0.44 ng/mL. They provided me with the reports from the CT angiogram and echocardiogram.

Am I at risk of dying in the next one to three years because of the elevated troponin? For over six months, I have been experiencing symptoms consistent with a heart attack, including intermittent central chest pain, bilateral arm pain, shortness of breath, palpitations, backache, a resting heart rate of 110 beats per minute, jaw pain, and severe fatigue. I am also suffering from nausea, IBS (irritable bowel syndrome), gastritis (diagnosed by endoscopy), dizziness, possible costochondritis due to rib pain, and intermittent pain when breathing. The Glyceryl trinitrate (GTN) spray has helped ease the pain, but it has not eliminated it.

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

First of all, I want to clarify that an increase in troponin levels is not a criterion for determining whether a person will live for one to three years. Someone has misguided you, and you are feeling unnecessary panic. Secondly, I will address your concerns step by step, but before that, I have a few questions:

What is your age?
How many episodes of chest pain have you had?
Are you a smoker? If so, please elaborate on how much and how long you have been smoking.
What is your body type—obese, thin, or normal?
How frequently do you experience palpitations?
When was your gastritis diagnosed, and have you received any treatment apart from antacids?
Have you experienced GERD (gastroesophageal reflux disease)?
Are your palpitations or pain associated with meals?
What is your lifestyle like in terms of appetite, sleep, stress, and physical activity?
Have you ever had your blood pressure and lipid profile (cholesterol) checked?

Troponin is a type of cardiac-specific enzyme that only increases when there is an injury to the myocardial muscle, which is the heart muscle. This injury could be due to direct trauma or ischemic injury from a lack of blood supply. I reviewed your CT (computed tomography) angiography report (attachments removed to protect the patient’s identity), and it suggests that you do not have any blockages, which means there is no need for excessive panic, as the report is favorable.

Once troponin levels rise, they can remain elevated for several days, and in some individuals, it may take longer to return to normal. Based on your symptoms, it is possible that you are experiencing unstable angina, a transient state of myocardial infarction (small heart attack) where the artery supplying blood to your heart narrows temporarily, leading to the release of troponin. However, this condition is not permanent, so there is no need to worry, but we should evaluate it properly.

Glyceryl trinitrate (GTN) spray causes vasodilation (dilation of the heart arteries) and is often given to patients with unstable angina. If you are not experiencing significant relief, it may be worth considering that you also have symptoms of costochondritis, which can contradict each other.

Given your heart attack symptoms, my advice is to undergo a stress echocardiogram or TMT (treadmill test), a lipid profile, and an ECG (electrocardiogram). Additionally, please send me the details of your current medications. In the meantime, I recommend the following:

Take Aspirin 150 mg once daily after a meal.
Take Clopidogrel 75 mg once daily.
Take Omeprazole 20 mg twice daily on an empty stomach in the morning and before dinner.
Take Propranolol 20 mg whenever you feel palpitations.
Take Alprazolam 0.25 mg once daily at bedtime.
Take a multivitamin once daily for 15 days.
Apply topical anti-inflammatory gel locally to the area of pain.

Consult your specialist doctor, discuss with him or her, and take the medicines with take the medicines with their consent. You should also focus on raising your good cholesterol (HDL), which is beneficial for your heart. If you are a non-vegetarian, include fish and fish oil rich in omega-3 fatty acids to help increase HDL levels. Foods that can help include whole grains, whole wheat products, almonds, and nuts. Fibrates like fenofibrate are very useful, and niacin (Vitamin B3) can effectively increase HDL levels.

Follow lifestyle modifications such as quitting smoking, exercising, and avoiding oily foods. There is no reason to panic. Do not overthink things, and avoid believing in myths. Cheers, and enjoy your life!

Thank you.