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Elevated Heart Enzymes. No heart attack.
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Elevated Heart Enzymes. No heart attack.

I am a 43 year old male that was admitted to hospital last week after experiencing chest pain.  Blood test results indicated elevated heart enzymes.  They gave me a heart cath and the result showed a healthy heart with no blockages.  They decided to do a scope into my gastro system and discovered I had ulcers in my esophagus, a fatty liver and a polyp in my gall bladder.  Advice from the stomach doctor was to lose weight and take Nexium which makes sense.   I asked if any of this would have caused my heart enzymes to elevate.  He said "no", and it doesn't make sense why my heart enzyme levels rose.  I believe my heart enzymes finally came down after a couple of days and I was released home.  The heart doctor has sent me letters explaining how to look after myself after a heart attack and recommended me to go to cardiac rehab.  I have a problem with this because I get the impression my heart is fine, or that is what they told me.  It is obvious I didn't have a heart attack.  I am relieved I am fine but it is bugging me as to why my heart enzymes rose.  None of the doctors seemed to have a clue.  They just say I had a heart attack which makes absolutely no sense.  I believe the doctors just put me in the too hard basket and told me I had a heart attack because they had no idea how to investigate further.  My blood pressure seemed fine, my heart rate was fine, my oxygen saturation was fine.  This really leads me to my only question, "why am I testing positive for a heart attack with elevated heart enzymes and the heart cath shows a healthy heart.?"
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Avatar_f_tn
First, which cardiac enzymes are you referring to?  Troponin? CPK (CK)?  OR both?  CPK can rise for a few reasons since it generally reflects stress on muscle tissue.  Had you been excercising prior or did you injure yourself in some way?  I had a friend who's CPK temporarily spiked up after she tried to move her son's weight equipment and it dropped on her arm.  There is also an autoimmune condition called Polymyositis which does elevate the CPK however many doctors are not very experienced enough with diagnosing this and you would need to be checked by a Rheumatologist.  As far as Troponin goes, I can tell you that last week I was in the hospital ER for the same reason....but my Troponin levels were .08 and then .05 a few hours later which is borderline, so the doctors there were not too alarmed. If your heart cath and EKG's were normal, and yet your cardiac enzymes were significantly higher than normal, there most probably is another issue that needs further investigation.  
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Avatar_m_tn
Thank you for the response clover43210.  I am not sure which enzymes they were.  I didn't have any other injuries.  Before he heart cath they told me the most likely scenario would be that I would need stents put in.  Other scenario could be that I would need open heart surgery.  None of these were needed.  They have sent my results to my GP and I have an appointment tomorrow to see him.  I will see if the report they sent him tells which enzymes were elevated.  If my cardiologist has no idea what happened, I am not sure how my GP will know anything different.
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Avatar_f_tn
Good idea to get copies of those results.  I understand your fear, because although one of the doctors told me he didn't feel my slightly elevated Troponin was anything serious to worry about, another doctor was acting like I was going to croak right there on the spot.  Two totally different opinions, so how is one supposed to trust either?  Polymyositis can affect the chest muscles... when I was at my worst back a few years ago, I remember feeling chest pain.  Curious if you have taken any cholestoral "statin" drugs?  I'd be interested in hearing an update when you find out more... be well.

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Avatar_m_tn
I just asked my wife if she remembers which enzyme was elevated. She said it started with a "T", so I presume it was the Tropoinin.  They tested for three apparently.
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Avatar_m_tn
At them moment they have me on a drug called Metoprolol.  I take half a tablet per day.  I don't think it is a cholesterol medicine.
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Avatar_m_tn
Metoprolol - It is a beta blocker - generic for Toprol.  Just a comment regarding your last post- personally I think it is important to know the names/dosages and reasons for the drugs you take.  On several occasions I was asked these questions and the nurse commented how important it is to know that info.  I have this info written down with me and in the car just incase I am unable to communicate. IMHO.
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Avatar_m_tn
Thanks curmudgen.  Very good point.
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Avatar_m_tn
I saw my GP today.  I asked him why my Troponin could have elevated.  He explained it was probably my esophagus that made them rise.  He also explained that the Troponin enzymes can rise for a lot of reasons.  Even anxiety can cause it.  I guess I will start making sure my esophagus gets better.

Thanks for your help clover43210 and curmudgen.
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Avatar_f_tn
Thank you for the update. I had never of that before since Troponin is supposedly very specific to the heart tissue... but I guess anything is possible.  Be well.
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Avatar_m_tn

Troponin is found in skeletal and cardiac muscle and is usually a marker for cardiac muscle damage.  The lower esophagus and stomach are lined with smooth muscle which does not use troponin.  I did a wiki search and could not find any reference to esophagus?????
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Avatar_m_tn
I find it interesting reading your comments and decided to google a bit.  It seems Pericarditis can cause a rise in Troponin and the symptoms seem very similar to what I had.  The pain has gone, so I don't beleive it is chronic and is probably over now anyway.  Nothing points to what my GP told me.  
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237039_tn?1264261657
Metoprolol is a beta blocker and helps to lower blood pressure and the heart rate. It is prescribed for angina and to help prevent a heart attack.  After taking this drug for several years I have become rather dependent on it.  I have a really bad day if I miss my dose. I take 100 mg every morning.  Since you have a healthy heart and feel that it wasn't a heart attack I would certainly discuss the use of this drug and I would give this some thought before getting started on it.  If there isn't any real need for it stop taking it.  Just my 2 cents.

Ally
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237039_tn?1264261657
"discuss this with your doctor" Typing too fast and left that out.
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Avatar_m_tn
Thanks ChatterAlly.  I am starting to think it would be a mistake to see my current doctors.  Nothing makes sense.  My heart rate and blood pressure were fine.  I am going to think about seeing another doctor.
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Avatar_m_tn
This conversation was fascinating! I'm a 56-yr-old female who was just in the ER/hospital/CCU for 3 days last week. Started with crushing chest pain, SOB, taken by EMS to ER. EKG was "borderline", 3 different sets of cardiac enzymes were elevated, ECHO normal, CATH normal, upper right quadrant ultrasound normal, upper GI barium swallow showed esophageal spasms and a large hiatal hernia. Sent home with no new meds and told to follow up with a GI doctor. Still wondering if I had a heart attack???
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976897_tn?1379171202
If you echo was normal, then you would have to conclude that you didn't have a heart attack. A myocardial infarction means the blood supply was cut off from part of the heart and would result in some heart muscle death. This would look pretty obvious on the echo, showing wall movement is abnormal.
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Avatar_f_tn
Please remember that vasospasms can also lead to a heart attack... I had a heart attack a few weeks ago and have unstable angina.

The heart cath showed that a small artery had collapsed... not a blockage, a collapse.  Nitro (given to heart attack patients) can make the small arteries re-expand.

My cardio enzymes continued to climb for three days then finally started to go back down.

I am home on meds, including nitroglycerin which I have had to use many times so far thanks to the unstable angina.

Never mess with the heart...
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Avatar_m_tn
same with me.after a tooth infection and flu like symtoms (symptoms) for 2 days i feel pain in my back and heavy sweting.i went to er and my enzymes was elevated. all the tests and a cath was clear. after 9 months i do some tests like egr and a triplet echo everything was fine.i think was myocaritis from the tooth infection.sorry for my english
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Avatar_n_tn
I sent you a message but I am in almost an identical situation as you. Diagnosed as a heart attack. They did a cath, I had no blockage, normal EKG, normal blood pressure, normal cholesterol, normal stress test. Only thing not normal was an elevated Troponin level. I am only 36 and pretty healthy.  Doctors say I had a heart attack and they don't take time to listen to my case or really stop and try to figure it out. So frustrating!! now I have this on my medical record saying I had a heart attack when I am pretty sure I didn't!!!
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Avatar_f_tn
Hi im a 23 yr old female with a pacemaker and ive been hospitialized over 100 times due to elevated heart enzymes. They keep me for a day or two but never find any new problems or cause. So im wandering why it is they go up so often.
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976897_tn?1379171202
Perhaps artery spasm?
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Avatar_m_tn
My dad just was released from the er with elevated Tropopin levels. And extremely high blood pressure. 3 weeks ago he had an angiogram. His heart was fine. But they did find that he had crazy high blood pressure. Why would these be elevated ifmhisnehart is fine. He was suffering from a horrible bout of the stomach flu the day this happened. Could that have helped it rise? S frustrated because the doctors didn't tell my mom any good info only that the angiogram probably didn't cause these to rise. Yet it says that this test can in fact raise Tropopin levels. Thanks for any help- a frustrated daughter.
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Avatar_m_tn
My dad just was released from the er with elevated Tropopin levels. And extremely high blood pressure. 3 weeks ago he had an angiogram. His heart was fine. But they did find that he had crazy high blood pressure. Why would these be elevated ifmhisnehart is fine. He was suffering from a horrible bout of the stomach flu the day this happened. Could that have helped it rise? S frustrated because the doctors didn't tell my mom any good info only that the angiogram probably didn't cause these to rise. Yet it says that this test can in fact raise Tropopin levels. Thanks for any help- a frustrated daughter.
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Avatar_m_tn
A clarification, why would these be elevated when his heart is fine? Sorry for the typo. Thank you
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976897_tn?1379171202
It was more than likely the very high blood pressure raising the enzyme levels. Is his blood pressure normal again now?
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Avatar_m_tn
I too was admitted to hospital after driving and my jaw went numb and a little pain, but first I drove home and called doctor, I had been seeing doctor for chest pain a few days prior...the doctor said go to the hospital, but I continued to stay home and do a little cleaning, until I started sweating and had trouble breathing, so I went to the hospital eventually...they at first said everything was fine, but wanted to admit for observation..i was pissed, due to cost. :)  but before I went up stairs and wife went home, they started giving me pills and potassium, when I got upstairs they came in with more pills and shots in stomach and said I was having or had a heart attack, did a cath next morning and found nothing, the cardio doc said when I went to his office to have my gp find out whats wrong, hearts fine and main arteries  are good, but the smaller vascular could have done something...gp (fill in for gp) said could've been a blood clot, or a spasm...explained very well...I will say when the cardio put me on a med it stopped my hands and feet from swelling, which occurred all the time from working, walking or sitting...but I also have asthma and a seizure disorder, so who knows...I think the docs want us going in diagnosing ourselves and then they treat that
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Avatar_f_tn
What a horrible and most scary experience & I'm still so confused on what happened to me . I'm a Zumba Fitness instructor & I was doing a routine when I had chest pain right after I stopped . I removed myself from the class and once the pain subsided a bit. I decided to go to the ER to make sure all was ok . Once there all hell broke lose EKG was negative through out my 2 days in the hospital. The ER cardiology doctor told me with out further testing at that time so cold and abruptly .. yes I am 90% sure you had a heart attack .. Omg ! I was in shock . the next day an echo gram & catheter was done all negative in fact the cardiologist who completed this test stated I had a beautiful healthy heart no attack . While my ER doc she later came to the room said congrats no Heart attack ,, I asked her why was she so sure initially scaring me half to death, she stated she was basing this on blood work that showed high enzymes . I am on Metoprolol and aspirin until I have a follow up that will not be with her , but the Doc who performed the catheter. I'm pretty healthy and vigil with my health , no cholesterol nor hypertension, I teach and hike stay very active . Now on these meds and feeling paranoid & scared . I have no clear answer she was not very informative with me and became defensive when I asked so many questions ,, Please tell me something I need piece of mind until my appointment not for almost 6 weeks she diagnosed me with Acute myocarditis  CONFUSED !
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Avatar_m_tn
Read up on prinzmetal's angina. My sister is going through the same thing- only 46 and healthy- and we think this might be what it will turn out to be.  Very scary.
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Avatar_f_tn
Gracias :} will do ...
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Avatar_f_tn
The same thing happened to me and it is soo scary and worrying.  I had been put on Levothyroxine a month beforehand in Dec 2013.  A bit stressed but nothing unusual.  I am a 57 year old Mum of teenagers, getting divorced and looking after my elderly Mum, so nothing unusual!  Everything was fine then my son just generally felt ill during January and stayed off school for a few days.  Then I felt ill and was sick for a few days staying in bed.  I remember being sick and ringing my friend feeling really down and in tears.  But while I was sick I remember feeling like a tearing in my neck, I thought at the time that it was unusual and I only brought up bile.  2 days later, after a really stressful day, I suddenly lifted a heavy shopping bag and suddenly got chest pain.  I assumed I had pulled a muscle in my chest.  It was late and I wanted to get home so drove home and when I got out of the car my back had a terrible ache, my arms were aching and my daughter called an ambulance.  After being given aspirin and a GT spray it subsided but I spent 3 days in hospital.  I was told I had had a heart attack and my troponin levels had risen from in the 200's to 2000.  EKG was normal, I was put on Clopidogrel and aspirin and on day 3 I was finally given an angiogram after being left off the list for several days.  Nothing was found, I had good clear arteries, cholesterol was 4.8.  I was allowed home with a follow up at the end of April and an echocardiogram  in April.  I had an episode of terrible anxiety and palpitations which I had since I was in hospital.  An ambulance was called but they said everything was ok and I was reassured that the ambulance woman had had the same thing.  I rang for an appointment with my doctor the next day and typical, I couldn't get an appointment but the duty doctor rang and gave me Diazepan.  I was telephoned by my doctor a week later saying that I was started on 50mg Levothyroxine which was too high and I was put onto 25mg Levothyroxine.  My palpitation stopped and most of my high anxiety and feelings of panic.  I kept thinking I was having another heart attack.  I have now finally had an echocardiogram and the operator said there was no abnormality and she couldn't believe that I had had a heart attack.  No damage was found.  Then I had a copy of a letter to my doctor from a different cardiologist saying I have a mild tricuspid valve regurgitation.  Nothing else, just that it is often seen in normal individuals.  My follow up has been put forward to now the end of May.  The nurses at rehab just say I am a mystery, but that doesn't help my worry.  I have mild waves of panic sometimes but its difficult to tell if it is my heart, side effects of the drugs I am still taking or this Levothyroxine which is all linked. I have taken myself off these poisoning and dreadful statins and thank goodness all my terrible aches have gone.  I just eat very well, stay off the cakes, biscuits and bad fats, have a 15 min fast walk in the evening and stay more active.  I take plant sterols, magnesium, garlic and resveratrol.  I have lost 1.5 stone and my belt is now at the tightest, yippee!  But I still constantly worry about my heart.  I just couldn't believe that I had a heart attack, unknown in my family, all lived to a ripe old age.  So been thinking that what if the Troponin levels can rise without a heart attack, glad its happened to other people, how many other people out there has it happened to I wonder?  I just feel as though been brushed aside and filed in the 'Mystery' file.  I don't like to have the label 'Heart Disease' or 'Heart Attack Victim'.  
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976897_tn?1379171202
There are more episodes like yours than you realise, where you go to hospital have an angiogram and no blockage is found. I had the same thing with my last attack a few months ago. It was explained to me that sometimes a clot may form and it disperses quickly enough to prevent damage. The administering of GTN, aspirin and clopidogrel can overcome this quite quickly. You were likely also given an injection of Klexane in the abdomen to thin the blood even more and this can cause some bruising in the area. If you are on Aspirin now, the is much less likely to happen again and if you are also on Clopidogrel then the risk is even less. I have no idea what your diet is like, but if you had a fairly high natural clotting factor, eating lots of vitamin K can increase this quite substantially.
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Avatar_n_tn
Dramlouie, if you haven't stumbled on it yet, you should google tako-tsubo syndrome. I had a similar incident earlier this year (elevated enzymes but negative angiogram) and it was one of the things my cardiologist suggested. As diagnosis He said some people, under great duress (like death of a loved one, divorce, etc) can actually have this happen.
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