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4.5 Troponin but No Heart Damage? (long)
Hello there,
I am a 49-year-old woman of average weight but with growing belly fat. I exercise fairly regularly but haven't watched my cholesterol levels. Over the years, I've been a vegetarian but have eaten a lot of dairy, fat and oil in my diet. I have a brother who had a severe blockage and double-bypass at age 50. I am also half Mexican which puts me in a higher risk category, from what I have read. The only health problem I had was depression and iron deficient anemia which was almost completely corrected through iron supplements and Wellbutrin.
Then last week I had a heart attack after walking up a steep hill. I had severe chest pain, starting from the right side of my chest and spreading to the left side of the chest and upper back. I was sweating but did not feel nauseous or weak. The intense pain lasted a few seconds and then subsided in the next few minutes. Then I just felt uncomfortable like something was stuck in my upper back. I walked the half hour home and then went to the ER.
In a series of tests, my ECGs were all normal. Over the next 18 hours, my Troponin level was .7 then 2.0, and then 4.5. They did an angiogram and the cardiologist said that a small artery was 90% blocked but that it was too small to insert a stent or balloon. He said that my heart and main arteries looked great.
The cardiologist then told me that I'd had a heart attack but no heart damage. I asked him how I could have no heart damage when my troponin was elevated to 4.5. He said that the heart had released troponin because the affected artery was dying. He also said that he had to put me on Plavix and Zocor (Simvastatin) for a year so that the small artery wouldn't die too quickly because that could result in another heart attack. He did say that new arteries were already growing to replace the dying ones.
I will see my cardiologist in a few weeks, but I'd like to have my questions ready for him. Right now my questions are these:
1) Could a person have a heart attack with chest pain, a fine ECG, and troponin level of 4.5 but not have damage to the heart muscle?
2) If there is damage to the heart muscle, can it be healed or is that part of the heart dead and scarred over forever?
3) Do survivors always have to stay on aggressive meds for a whole year or can the meds be reduced if Cholesterol goes down when the Esselstyn diet is followed? (When I left the hospital, my lipid panel was Cholesterol - Overall: 191 mg/dL, HDL 47, LDL 126, Triglyceride 87.)
Any insights are appreciated. I'm hoping I can ask my cardiologist if we can reduce my med doses in a few months if I improve my cholesterol through dietary changes and continue to exercise and reduce stress. (Meds are at Zocor (Simvastatin) 40mg/day and Plavix 75mg/day, plus Bupropion (Wellbutrin) 200 mg/day. I have an intuitive sense that I would feel better if the med doses were lower.
Thank you for reading this and helping me understand heart disease. Have a wonderful day!
I am a 49-year-old woman of average weight but with growing belly fat. I exercise fairly regularly but haven't watched my cholesterol levels. Over the years, I've been a vegetarian but have eaten a lot of dairy, fat and oil in my diet. I have a brother who had a severe blockage and double-bypass at age 50. I am also half Mexican which puts me in a higher risk category, from what I have read. The only health problem I had was depression and iron deficient anemia which was almost completely corrected through iron supplements and Wellbutrin.
Then last week I had a heart attack after walking up a steep hill. I had severe chest pain, starting from the right side of my chest and spreading to the left side of the chest and upper back. I was sweating but did not feel nauseous or weak. The intense pain lasted a few seconds and then subsided in the next few minutes. Then I just felt uncomfortable like something was stuck in my upper back. I walked the half hour home and then went to the ER.
In a series of tests, my ECGs were all normal. Over the next 18 hours, my Troponin level was .7 then 2.0, and then 4.5. They did an angiogram and the cardiologist said that a small artery was 90% blocked but that it was too small to insert a stent or balloon. He said that my heart and main arteries looked great.
The cardiologist then told me that I'd had a heart attack but no heart damage. I asked him how I could have no heart damage when my troponin was elevated to 4.5. He said that the heart had released troponin because the affected artery was dying. He also said that he had to put me on Plavix and Zocor (Simvastatin) for a year so that the small artery wouldn't die too quickly because that could result in another heart attack. He did say that new arteries were already growing to replace the dying ones.
I will see my cardiologist in a few weeks, but I'd like to have my questions ready for him. Right now my questions are these:
1) Could a person have a heart attack with chest pain, a fine ECG, and troponin level of 4.5 but not have damage to the heart muscle?
2) If there is damage to the heart muscle, can it be healed or is that part of the heart dead and scarred over forever?
3) Do survivors always have to stay on aggressive meds for a whole year or can the meds be reduced if Cholesterol goes down when the Esselstyn diet is followed? (When I left the hospital, my lipid panel was Cholesterol - Overall: 191 mg/dL, HDL 47, LDL 126, Triglyceride 87.)
Any insights are appreciated. I'm hoping I can ask my cardiologist if we can reduce my med doses in a few months if I improve my cholesterol through dietary changes and continue to exercise and reduce stress. (Meds are at Zocor (Simvastatin) 40mg/day and Plavix 75mg/day, plus Bupropion (Wellbutrin) 200 mg/day. I have an intuitive sense that I would feel better if the med doses were lower.
Thank you for reading this and helping me understand heart disease. Have a wonderful day!
I was put on 75mg of aspirin, which will be for life and is a standard thing here in the UK. I was also put on Plavix for 12 months, due to having a stent. I'm back on it again now, due to 5 more stents and this time probably for 3 years. You are correct about stress. All my problems began when I had huge stress levels. With the society of today, both US and UK, I think it's getting almost impossible to avoid it. If they want to reduce the cases of heart disease, I think they need to overlook our society, pump money into that, rather than into drugs, half of which won't be required.
Interesting about the liver--didn't know that. I do know that my mother eats a vegan plant-based diet but still has high cholesterol. Lots of heart disease on her side of the family. She hasn't had it but she cultivates a stress-free lifestyle.
No I have never smoked so that's not a factor for me. Stress could be and I'm starting a new job next week, so I'm hoping I'll be able to pace myself and not get too overloaded. I'm going to try the Esselstyn diet and hope it works for me. I
Did you take Plavix or any other blood thinner after your heart attack?
No I have never smoked so that's not a factor for me. Stress could be and I'm starting a new job next week, so I'm hoping I'll be able to pace myself and not get too overloaded. I'm going to try the Esselstyn diet and hope it works for me. I
Did you take Plavix or any other blood thinner after your heart attack?
I have a very hyperactive liver which produces cholesterol by the bucket load. Diet will never help me, I have to use statins, 40mg a day. I've been taking them since Feb 2007 and never had an issue. I also take Ezetimibe which helps prevent fats being absorbed through the gut. Together, they have brought my cholesterol right down. Diet helps a few people, but the Liver has the ability to make fats whether you eat them or not. With these wonderful meds, I can eat lots of chocolate still, because I have a very sweet tooth. I don't think I could handle diets lol.
One thing I haven't mentioned is smoking, because this is obviously a major contributor to artery disease. Do you, or have you ever smoked?
One thing I haven't mentioned is smoking, because this is obviously a major contributor to artery disease. Do you, or have you ever smoked?
Yes, the heart *is* wonderful! Thank you for your reply. I am learning more about the collaterals from the net, so I follow you there (the nurse had called them new arteries, but I see now that they're not). Thank you again. I'd love to get off the Plavix. Did you have to take it? I'd also love to lower my statin. My brother had a double bypass and only takes 5mg of statin while I'm on 40mg. I know it's early still but the sooner I can lower these doses, the better I'll feel about it. I am determined to follow Esselstyn's diet. Do you do that or something else?
"1) Could a person have a heart attack with chest pain, a fine ECG, and troponin level of 4.5 but not have damage to the heart muscle?"
Absolutely. Heart muscle begins to release the enzyme in question when it starts to be a bit low on oxygen to use for energy. If SOME level of oxygen is reaching the muscle area, it will still function, but with less efficiency and once blood flow is restored it should fully recover. Only when oxygen is cut off will necrosis kick in, complete suffocation.
"2) If there is damage to the heart muscle, can it be healed or is that part of the heart dead and scarred over forever?"
I think, (I could be wrong when it happens), when in the womb, the heart cells multiply to develop the organ. Once fully developed, heart cells are stripped of their ability to multiply and so we are left with the same cells for the rest of our lives. Research has found the protein responsible and is attempting to unlock this process, so we can have new cells. One dead, heart tissue remains dead.
"3) Do survivors always have to stay on aggressive meds for a whole year or can the meds be reduced if Cholesterol goes down when the Esselstyn diet is followed? (When I left the hospital, my lipid panel was Cholesterol - Overall: 191 mg/dL, HDL 47, LDL 126, Triglyceride 87.) "
Well, once coronary artery disease shows its ugly face, we have to take it seriously and make very big lifestyle changes if we want a long life. Obviously if we make no changes, the disease will grow and start to affect more vessels. Diet is not enough with most people and this is because the food we eat only accounts for a small proportion of the fats in our blood (cholesterol). The Liver is the culprit. It performs over 200 tasks in the body and one is to make lipids for fat transportation. The best way to reduce this, is to take statins. However, there are other benefits to statins being found all the time. It reduces inflammation, especially in the arteries which is a major factor in artery disease. Some research has apparently shown that aggressive usage of statins can reverse artery disease. I'm not sure how plavix would really help with the blockage, apart from maybe reduce your ability to form a clot in the area. Aspirin is the usual medication if you have no stents.
"He did say that new arteries were already growing to replace the dying ones. "
Not strictly true. But I think he was just simplifying things for you. Those vessels are called collaterals and already exist but are closed. When pressure gradients exist in vessels due to blockages, then in some people these vessels open up to give a natural bypass. They receive their blood from the other side of the heart and feed it across to the muscle which needs it. This is another reason why heart muscle doesn't always die. Even when someone gets a total blockage, collaterals can open up saving the muscle. My left artery was completely blocked at the top, which kills most people, but collaterals fed into the bottom, keeping the muscle alive. Isn't the heart wonderful.
Absolutely. Heart muscle begins to release the enzyme in question when it starts to be a bit low on oxygen to use for energy. If SOME level of oxygen is reaching the muscle area, it will still function, but with less efficiency and once blood flow is restored it should fully recover. Only when oxygen is cut off will necrosis kick in, complete suffocation.
"2) If there is damage to the heart muscle, can it be healed or is that part of the heart dead and scarred over forever?"
I think, (I could be wrong when it happens), when in the womb, the heart cells multiply to develop the organ. Once fully developed, heart cells are stripped of their ability to multiply and so we are left with the same cells for the rest of our lives. Research has found the protein responsible and is attempting to unlock this process, so we can have new cells. One dead, heart tissue remains dead.
"3) Do survivors always have to stay on aggressive meds for a whole year or can the meds be reduced if Cholesterol goes down when the Esselstyn diet is followed? (When I left the hospital, my lipid panel was Cholesterol - Overall: 191 mg/dL, HDL 47, LDL 126, Triglyceride 87.) "
Well, once coronary artery disease shows its ugly face, we have to take it seriously and make very big lifestyle changes if we want a long life. Obviously if we make no changes, the disease will grow and start to affect more vessels. Diet is not enough with most people and this is because the food we eat only accounts for a small proportion of the fats in our blood (cholesterol). The Liver is the culprit. It performs over 200 tasks in the body and one is to make lipids for fat transportation. The best way to reduce this, is to take statins. However, there are other benefits to statins being found all the time. It reduces inflammation, especially in the arteries which is a major factor in artery disease. Some research has apparently shown that aggressive usage of statins can reverse artery disease. I'm not sure how plavix would really help with the blockage, apart from maybe reduce your ability to form a clot in the area. Aspirin is the usual medication if you have no stents.
"He did say that new arteries were already growing to replace the dying ones. "
Not strictly true. But I think he was just simplifying things for you. Those vessels are called collaterals and already exist but are closed. When pressure gradients exist in vessels due to blockages, then in some people these vessels open up to give a natural bypass. They receive their blood from the other side of the heart and feed it across to the muscle which needs it. This is another reason why heart muscle doesn't always die. Even when someone gets a total blockage, collaterals can open up saving the muscle. My left artery was completely blocked at the top, which kills most people, but collaterals fed into the bottom, keeping the muscle alive. Isn't the heart wonderful.
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