Elevated cardiac enzymes, no heart attack

[lovethesun76]

I am a 34 year old female, healthy in all areas.  On a side note, I did have a left sided ischemic stroke on 6/20/10, where I was left paralyzed on my right side and unable to speak.  Thankfully I have made an excellent recovery and the only remaining side effect is Horner's Syndrome in my eye.  The stroke was caused by a dissection in my left internal carotid artery, where I've since had 2 stents placed.  I also have a dissection in my right internal carotid artery and right vertebral artery.  The doctors believe it's a genetic condition causing this but haven't done much testing.

Onto the heart issues.  Over the past 9 months there have been two times where I've had to go to the ER due to shortness of breath and mild chest pains.  The shortness of breath occured while I was sitting down and was not doing anything active.  They drew labs at the ER and my troponin and other cardiac markers came back very elevated, although my EKG was normal both times except for a fast heart rate.  They did a cardiac echo and that was abnormal, showing a decreased EF of about 46%, along with a left ventricular wall motion abnormality.  

The doctors had no explantion as to why all of my cardiac markers were elevated, or what had caused the abnormal cardiac echo.  At one point they did an angiogram to check for any blockages but everything was fine.  I've had various episodes of passing out, along with some instances where my heart rate will be around 155 when I'm not active.  My blood pressure tends to run on the low side, with my normal being somewhere around 108/65 or so.

Do you have any thoughts as to why my cardiac enzymes would be elevated w/out a heart attack?  And why my EKG would be normal during all of this?  I'm only 34 and between the stroke and these cardiac incidents, I'm honestly a little worried about what my long term future looks like!  Thank you for any input, thoughts or suggestions you can offer (diagnostic tests?) - it is truly appreciated!

Adrienne

[CCF HeartMD-1]

Also, I would probably also image your aorta in some way (CT scan or an echo can usually see some of the aorta) to make sure it is not dilated because this can go along with genetic collagen-vascular disorders.  

Your heart rate issue also is not abnormal and you should have a Holter monitor to see if your are having some type of arrhythmia at times.  

[CCF HeartMD-1]

I forgot, you should also have formal genetic testing for these collagen-vascular disorders that I mentioned above which we do routinely here at the Cleveland clinic.

[CCF HeartMD-1]

It could be that you had coronary vasospasm (spasm of the main coronary arteries) that caused your EF to be a little low at 45% with a wall motion abnormality and elevated cardiac enzymes without significant blockages.  Normally we would see some EKG changes but not all of the time!  To rule out coronary vasospasm we can do a special cardiac cath with ergonovine which is a medication that can induce spasm in people who are prone to spasm and this is done in the catheterization laboratory.

I am also very concerned about your carotid dissections and at your young age I would want to make sure you don't have some type of collagen-vascular disorder such as fibromuscular dysplasia (FMD), ehrlos-danlos or lois-deitz which are all disorders of the vessels and can sometimes affect the coronary arteries also of the heart but we would usually see abnormalities of them during the heart catherization which your doctors did not see.  

You should have carotid ultrasound studies done to rule out these special disorders and/or a CT scan of the neck arteries and brain or an MRI of the neck arteries and brain for further evaluation.  We have vascular medicine specialists here at the Cleveland Clinic, Dr. Heather Gornik, who specializes in these disorders or may know of someone closer to where you live who could further evaluate you.  

Hope this helps.  Good Luck!

[bobby1964]

I'm still curious about these emzymes.  

crp < 5 mg/l 7*  cpk <180 u/l 427*  troponin - t <0.05 ug/l ldh 240 - 480  u/l

Keep asking doc but get no answers. He either changes the subject and still tells me not to worry.  Could somebody at least explain these enzymes to me idividually.

[CCF HeartMD-1]

I think I would do a consult with Vascular Medicine (although I just asked Dr. Gornik) and their department doesn't do it yet.  So, this is somewhat difficult. You could consider neurology or genetics.  Coming in person would be better of course!!!

[lovethesun76]

I'm sorry but I have one more question!   I was looking at the Cleveland Clinic's website to possibly do an online consult but I'm not sure what specialty I should go with.  Cardiology, vascular, neuro, genetics, etc.  It seems like there's a little bit of each area involved.  What would you suggest?  Thanks once again!

Adrienne

[lovethesun76]

One more thing...  when I was first hospitalized after the stroke they did an echo of my aorta and everything looked good.  My doctors have said that is something I will need to have monitored over the years because of the three other dissections.  I just wish I knew what caused those dissections so that I will at least have an idea of what to expect in the future!  It sounds like this is something that Dr. Gornik can help me with.  At this point I'm willing to do what it takes to get this figured out, and my family is very supportive of that as well.

[lovethesun76]

Thank you so much for your reply!  After the stroke the doctors mentioned Ehlers Danlos syndrome (sp?) but I haven't had any testing done for that.  They ruled out FMD because there was no "string sign" on the scans... at least I think that's the way the phrased it!  I had the stent procedure done at UCSD (I live in San Diego) and prior to the surgery they had suggested I get a second opinion from somewhere like Mass General or Cleveland Clinic.  The dissection in the left carotid artery went high into the base of my skull and they said the procedure was very risky and that they normally don't operate when it's that high, but they felt that the risks of not doing the surgery outweighed the risks of doing the surgery.  Thankfully everything went fairly smoothly.

I just had a tilt table test and will be meeting with my cardiologist in a week or so to go over the results.  I did fine throughout the entire test until they gave me a shot of medication (don't remember what med it was).  After about 4 minutes my blood pressure was at 62/30 and I was as close to passing out as one can be without actually passing out.  My heart rate was over 100 throughout the entire test and I think the highest it got to was about 160 or so.  My cardiologist is great and very experienced but he is not sure what is causing all of this.  Does the Cleveland Clinic do online consults - sending my test images, reports, etc, to have a fresh pair of eyes looking at all of this?  Thanks again for your feedback!
Adrienne