Continued Elevation of Troponin T Enzyme

[lori8571]

4 years ago my Dad was turned down twice for bypass surgery, balloons, and stints.  His condition was considered too dangerous to do anything but medicate.  A year later the doc, thought that he was healthy enough for surgery.  The doc ended up doing 6 bypasses three years ago.  On Saturday, Dad was working outside (it was 95 degrees out) doing carpenter work.  Later that night, he went out to eat and when he returned home he started experience burning in his chest.  His arms were hurting, but he couldn’t be sure that it wasn’t from the work he was doing earlier in the day.  He thought that he might have severe indigestion, so he suffered all night with the burning in his chest, which seemed to be located under his scar.  The burning never completely went away and the next afternoon he decided that he needed to go to the ER.  When we got there, the ER doc thought that it might be indigestion, but because of his history decided to do a complete work up.  They immediately put a nitroglycerin patch on him.  His EKG showed that he had an inverted T wave and his Troponin T count was 38, which suggested a “cardiac event.”  They admitted him to the hospital for monitoring and to await a heart cath.  They have been monitoring his enzyme levels, and yesterday (Monday) his enzyme count went up to 41.  The doctor is slightly confused because he is not experiencing any of the heart attack symptoms, yet his enzyme level is rising.  He hasn’t had any burning in his chest since Sunday afternoon (after the patch), no nausea, and no numbness in his arms.  All things considered he feels really good.  A heart cath is going to be done today (Tuesday) at 2 pm.  My question is, why is his enzyme level rising?  Could this be a prelude to a heart attack about to happen?  If so, is/can the nitroglycerin patch fight this off?  How risky is it for them to be doing a heart cath at this point?  The doc has told him that he should be prepared to do a balloon, stint, or possibly another surgery.  

[Cleveland Clinic]

lori,

thanks for the post.

My question is, why is his enzyme level rising?

Its complex, but has to do with the kinetics of troponin release and kinetics in the body.  Troponin is released very early from the heart in response to ischemia.  This is why its a good marker for cardiac ischemia. Once its released it is cleared from the body slowly, so you are probably seeing the result of the initial release from when he had the symptoms that caused him to go to the hospital.

Could this be a prelude to a heart attack about to happen?

In essese he already had the prelude to the heart attack.  The symptoms, his history and his positive troponin are part of an entity known as an acute coronary syndrome. This is caused by an unstable plaque in the coronary artery. His prompt action of getting to the doctor where they could treat him with medications to attempt to stop the processmost likely kept him from having a frank heart attack.

If so, is/can the nitroglycerin patch fight this off?

Nitro helps along with other medications to affect the paltelets such as aspirin and heparin and other medications to help the heart 'rest' such as beta blockers.

How risky is it for them to be doing a heart cath at this point?

While there is some risk in a heart catheterization, obviously something is happening in the arteries of the heart. It is the next natural step in the process.

The doc has told him that he should be prepared to do a balloon, stint, or possibly another surgery.

These are likely possibiliites.


good luck. Update us on what happens.

[lori8571]

The heart cath was postponed until yesterday (Wednesday) because the doc had an emergency at another hospital.  Because I was not able to be there when the doctor spoke to my family, I don't have all the details.  But they ended up doing the heart cath which showed almost 100% blockage to one of his vessels.  They put 2 medicated stents back to back in that vessel to get the blood flowing again.  The doc also told the family that one of the 3 major graphs (spelling?) he did 3 years ago has collapsed and that there is nothing he can do for that.  He said that the graph may have collapsed shortly after the surgery and may not have been a result of the heart attack because his vessels were so diseased when he did the surgery.  My Dad will be on blood thinners for the rest of his life and has to make a major lifestyle change, including losing weight.  The Doc said that this is the last patch he can put on him, and hopefully in a couple of years there will be new technology out that they can experiment with.  I'm really not sure what the graph is, can you explain it to me?  Also, do you know of other options that might be available in the future that the doc was refering to?