Raise in troponin level has high chance of mortality. Is that true?

Patient's Query

Hi doctor,

Six months back, I had an echocardiogram and a CT angiogram. My initial troponin T level was 0.44. After six hours it dropped back down to below 0.10. My test results from the CT angiogram were normal and the calcium level was 0. My echo was also normal. I wore a monitor for seven days and that too normal. I have read that because of my troponin raise I have a high chance of mortality within 1-3 years. My GP could not explain why my troponin was raised.

I did have an agoraphobic panic attack. At that time I feel some pain travels from my heart down my arm to my thumb like a lightening bolt. This is the reason why I went to hospital and they kept me in due to the raised 0.44 level. They gave me the reports of CT angiogram and echo. Am I at risk of dying in the next 1-3 years because of elevated troponin? I have had heart attack symptoms such as intermittent central chest pain, bilateral arm pain, shortness of breath, palpitations, back ache, fast heart beat at 110 beats at resting and jaw pain for over six months. I am also suffering from nausea, IBS, gastritis (endoscopy diagnosed), severe fatigue, dizziness, possible costochondritis due to rib pain and intermittent pain when breathing. GTN spray helps by easing the pain but not to get rid off it.

Answered by Dr. Amit Arora

Hi,

Welcome to icliniq.com.

First of all I would like to make it clear that raise in troponin level is not criteria whether a person will live 1-3 year. Somebody had totally misguided you and you are getting panic unnecessarily.

Secondly, I will clear your doubt step by step. But, before that I want to ask few questions.

What is your age? Since how many times did you had episode of chest pain?

If you are a smoker then please elaborate how much and since how long you had being smoking?

What is your body stature; obese, thin or normal? How much frequent you suffer from palpitations?

When did gastritis was diagnosed? Had any kind of treatment apart form antacid?

Did you suffer from GERD (gastroesophageal reflux disease)? Did palpitation or pain associated with meals?

What is your life style, appetite, sleep, stress and physical activity?

Have you ever get your blood pressure and lipid profile (cholesterol) done?

Troponin is a kind of cardio-specific enzymes which get raised only when there is injury to myocardial muscle that is heart muscle.The reason could be a direct injury or ischemic injury due to lack of blood supply or anything else.

I read your CT guided angiography report. It is suggestive of that you do not have any kind of blockade. So, you should not be so much panic as report goes in your favor.

Once troponin level get raising it remain elevated for several days and in some person it take long time to become normal

According to your symptoms, I think that you could have unstable angina. It is a transient state of MI (small heart attack) in which artery supplying to your heart become narrow for time being and lead to release of troponin. According to report that is not permanent so nothing to worry. But, still we have to evaluate it properly.

Glyceryl trinitrate - GTN spray will cause vasodilation (dilation of arteries of heart) and given in patient of unstable angina. Moreover, you do not get relieve too much as you also have a doubt about costochondritis. Both the things are contradicting each other.

As you have described about some heart attack symptoms, my advise is to get a stress echo or TMT, lipid profile and ECG done. Also send me the details of your current medication.

Till then I will advise you to take the following medicine:

Tablet Aspirin 150 mg once daily after meal.
Tablet Clopidogrel 75 mg once daily.
Capsule Omeprazole 20 mg twice daily in empty stomach in the morning and before dinner.
Tablet Propranolol 20 mg whenever you feel palpitations.
Tablet Alprazolam 0.25 mg once daily at bed time.
Tablet Multivitamin once daily for 15 days.
Apply topical anti-inflammatory gel locally in the area of pain.

You need to raise your good cholesterol level which is HDL (high-density lipoprotein) which is good for heart. If you are a non-vegetarian then fishes and fish oil which contain Omega-3 fatty acid to increase HDL levels.

Some food product which can increase are whole grains, whole wheat products, almonds and nuts. Fibrates like Fenofibrate very useful. Niacin (Vitamin B3) is very useful in increasing HDL levels.