Hi, my wife suffers from polymyositis and has recently been experiencing chest pain/tightness and left arm pain. Her ecg was normal however blood tests revealed troponin T levels are elevated to 492 ng/L, how high is this on the scale, i.e. Is it seriously high?
She sees her specialist next week who wants to start her on some bolus cyclophosphamide, what does all this mean?
To properly answer your question I first need to clarify the troponin T result. Troponin T levels are normal between 0.00 and 0.10 ng/ml. The units in your question are in ng/L but I suspect that the value obtained was 0.492ng/ml, consistent with an abnormal elevation in troponin T. If on the other hand the value is 0.0492ng/ml then this value is within the normal range as indicated above.
Troponin T is referred to as a ‘cardiac biomarker’ and is used to detect cardiac injury. When heart muscle cells are damaged, troponin T is released into the blood stream and can be detected in blood tests. Values higher than 0.10 have been shown to have prognostic value meaning that they can predict future negative changes in a patient’s health. The classic reason for troponin T levels being increased is a heart attack in which blood flow to the heart is reduced, or stops, because of blockages or narrowings in the blood vessels that supply the heart (coronary vessels). However, troponin T can be increased in other conditions such as inflammation of the heart muscle (called ‘myocarditis’), clots to the lungs (called ‘pulmonary embolism’), and even kidney disease.
A complete understanding of your wife’s medical condition is necessary to properly answer your question. In addition to the history of polymyositis it would be important to know about family history of heart problems and other risk factors for heart disease such as smoking, high blood pressure, high cholesterol, diabetes, and kidney disease.
Elevations in troponin T may be found in up to 25% of patients with polymyositis. It is not uncommon for the EKG to be abnormal. The clinical implications of troponin T elevations in polymyositis are not entirely clear, however reduced heart function is common and this suggests some degree of heart muscle injury is occurring. Cyclophosphamide can be very useful in patients with conditions such as polymyositis and works by restoring the balance of an overactive immune system. Your wife’s specialist will be the best person to discuss this medication and its side effects with.
Cardiologists follow up on an abnormal troponin T result by tracking how it changes over time. Patients with an abnormal troponin T but who are otherwise stable and do not have an indication for immediate tests to rule out a heart attack (on the basis of chest pain and a markedly abnormal EKG) can be monitored with a repeat troponin T in 3 hours. How troponin T changes over time is important in estimating risk and deciding on additional tests. Further tests range from an ultrasound of the heart to a test called an angiogram, in which we look directly at blood flow to the heart to rule out narrowings or blockages. Cardiac MRI or CT can be useful in some cases.
If the original value was 0.0492ng/ml it is reasonable to have this repeated when you visit your wifes specialist. If the value is 0.492ng/ml and a repeat troponin T not been done and/or your wife is continuing to experience chest pain, I recommend that you visit your local hospital emergency department as soon as possible for a repeat troponin T. Other tests may include a repeat EKG and blood work including blood count, electrolytes, kidney function, inflammatory markers, and CKMB (another marker of heart damage)]. In some cases, the first result was incorrect and we can feel relieved. On the other hand, a rising troponin T requires further evaluation in hospital with a cardiologist. Serial increases in troponin T can signal progressive heart injury and a higher risk of complications such as changes in rhythm or heart function.
Chest pain that is persistent or increasing over time requires immediate medical assessment and transfer to hospital by calling an ambulance.
Take care and please update me once you have spoken with your local health care team.
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