Troponin Level and Heart Tests

My wife (30 years old) has recently underwent surgery to remove a large benign retroperitoneal tumour whcih was laying on the aorta. The operation was a success but whilst in the intensive care unit, her ECG displayed a left bundle branch block.....this was after a couple of normal ECG's. Subsequently, troponin blood tests came back elevated at 0.13 indicating some damage, she then underwent an echo which came back normal, an angiogram which again came back normal, subsequent ECG's returned normal patterns and two further blood tests over the following 48 hours returned to normal levels. I spoke to the cardiologist briefly and he said that from a heart perspective all was fine as a result of the test results obtained.

I have read in detail about the sensitivity and accuracy of tropinin testing but am struggling to understand how the level was elevated indicating damage but subsequent tests do not back this up and I understand in the event of eleveated troponin, they remain elevated for a period of days, however, my wife's returned to normal almost immediately.

My question is, did my wife have a heart attack during or after the op (3 hours) or could the troponin level have elevated due to the trauma of the operation or another reason. Can my wife carry on her lifestyle as before and also interpret the heart scan and angiogram results that she is free of any kind of heart disease and that her heart is in full healthy working order?

Your view is very much appreciated.

[CCF-M.D.-MJM]

Hi Rob,

I am glad everything went well with the surgery and that all the cardiac tests were normal.  It is true that troponin is very sensitive and specific for heart damage, but this is a very low positive result.  I would be very surprised to see a 30 year old have a post op MI.  A positive tropinin may also indicate heart strain - this could happen with a blood clot as well.  In fact, a pulmonary embolism would be first on my differential diagnosis before think of cardiac problems.  Did they do a VQ scan or CT angiogram to rule out pulmonary embolism?

Based on the test results, I don't think she should have any problem returning to her normal pre-op activity, but make sure your doctor agrees before she does anything strenuous.

I hope this helps, thanks for posting.

[NanaRose]

I can sympathize with you.  I had a routine heart cath and an area was stented for what I was told, "pressure reading was elevated".  Not only did they not explain this to me, they sent me home and 2 days later I was back in ER not feeling well and my Troponin in ER was 0.58. Now this was 2 days after this heart cath/stent which the ER doctor said the Troponin level had to of been much higher right after the Cath and was on its way down when I went to ER, 2 days later.  The doctor on call told the ER physicain to send me home if I did not look bad as this level of Troponin was minimal and most likely I had a small injury to a vessel during the heart cath/stenting. I am having a hard time dealing with this statement.  The best test I was told to see if there was damages done, is a Cardiac MRI at a large teaching hospital that has an expereinced radiolgist that can read this and you sitting down with this radiolgist as many cardiologists do not know how to interpert these reports.  This will give you your answers, I believe..  Good Luck to you.

[NanaRose]

Hi Fwilson.

Perhaps the cardiac MRI did not work for you but this did show the problem for me. It is very sensitive and CC uses it quite often.

[jeff 67]

I sympathize with your problem, but your comments in this forum are often negative and not very supportive.

[Rob W]

The only tests my wife had were the echo and angiogram.............would these rule out a pulmoney embolism? Since returning home, she has experienced no heart problems and is recovering well, she has been discharged from the heart hospital as she was only transferred there as a day case to carry out the tests, as they were normal, no follow up from a heart perspective is planned.

Many thanks for answering my question and to all others for sharing their views and experiences.

[NanaRose]

When they suspected a PE in me, they ordered a CT chest scan with contrast. When hubby was having breathing difficulties soon after his surgery, the doctor in hospital orderd also A CT chest scan to rule out a PE. I have had about 15 Echo's and I am 99.99% sure that Echo's are not the test they use to R/O a PE.  I cannot comment on the angiogram as a diagnostic test for a PE. My guess would be that the CT chest scan would be a better choice. Again,I am guessing on the latter one.  Good Luck To you and your wife.

[yellowjacket69]

A related discussion, Troponin was started.