Elevated Heart Enzymes. No heart attack.

[jfhbiff]

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.?"

[Mac_MLJ]

Similar experience for me. Went to bed fine, woke up at 5am with dull pain in my chest that wouldn't go away so I drove myself to the hospital and, after sitting in the emergency ward for several hours and giving several blood samples, I (finally) got told I had raised troponin levels and so must have had a heart attack - right in front of my wife.
I kept getting told that's it due to my size and I should really think about losing weight but none of the medical staff seemed interested in the fact that I'd already lost over 40lbs in the 4 months prior, all they saw was a "big fat guy" who had raised troponin, chest pains and high blood pressure. EKG was fine. Oxidisation level was fine.
The fact that I regularly walked the 3 mile trip to and/or from work several days a week and (incredibly, given their reaction) could regularly climb stairs without being out of breath also seemed to baffle them.
I had an echo-cardiagram and a CT scan and both came back fine so, after 3 days of being sat in hospital, for only 1 hours worth of actual tests, wgich found nothing, they sent me home with a box of 30 soluble aspirin and a booklet on "how to cope after a heart attack."
They scheduled an MRI - which I couldn't fit into (I'm a 6ft 4 rugby player so, even without the extra fat, I'm not a small guy) and, after visiting my GP about increasingly regular abdominal pain and irregular bowel movements, I'm now on Omeprezole and have a liver ultrasound scheduled. She also suggested anxiety over being "investigated for a cardiac event" will probably raise my blood pressure a lot.
I still get pain but it's mostly situated more in my abdomen -
any cheat pain tends to largely dissipate after I burp; I seem to be living on ibuprofen and antacids and, over a month later, I'm still none the wiser.
All because I felt a bit off and wanted to get it checked.
I have an appointment with a consultant tomorrow, so I'm hoping I'll get some kind of answers or some idea of what's going to happen next.

[missdianne]

any more news on your follow up?

[April_Broxton]

When dealing with health problems and you have a smartphone download iTriage found in the play store. Download it!! As an ER nurse I encourage all my patients to have this in their phones and keep it updated. The medications you take now or have taken in the past will help your Primary Dr and local staff at a hospital or clinic to help diagnosis possible side effects that medications can also cause. In many cases, prolong use of many medications can have adverse effects on the patient. In the case, like the young man above, the chest pain may have been caused by a combination of prior medications and the current medication reacting upon each other.

It is vital that you talk to both your doctor and the Pharmacist about any medication that you are being asked to take. Many cases these days I watch doctors get cutbacks on passing meds that should not be passed on to some patients and I have stood up and backed many of the dr's into a corner. As a RN we are responsible for the patients health and by making sure that the doctor is giving the proper dosage to a patient and that the meds won't react upon each other. That will also include knowing all meds. That is where iTriage comes in handy. You can both currently meds with the dosage and time listed and your phone can give you an alter if there is something that can possibly cause you harm.

[Dramlouie]

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'.  

[Rr0321]

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.

[046]

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 !

[wayee60]

I just got back from a similar ordeal and am searching for answers myself. Have you ever had gall bladder issues? I have had some indications that this has also been the culprit. Have you gotten any answers since your post was 3 years ago?

[DiwaChennai]

I have similar tropnin increase but ECG adn Street test normal. I have Fatty lever , gallstone for quite some time(5years). Any answers/solutions since you have posted the finding?. Appreciate your response and help.

[newatthisone]

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

[nicki13378]

A clarification, why would these be elevated when his heart is fine? Sorry for the typo. Thank you

[nicki13378]

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.

[redrobin2013]

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!!!

[inwords]

http://www.health.harvard.edu/blog/stress-cardiomyopathy-a-different-kind-of-heart-attack-201509038239

[ed34]

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.

[jfhbiff]

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.

[ChatterAlly]

"discuss this with your doctor" Typing too fast and left that out.

[ChatterAlly]

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

[clover43210]

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.

[jfhbiff]

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.

[curmudgen]

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.

[jfhbiff]

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.

[clover43210]

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.

[jfhbiff]

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.

[thiscatiscurious]

What medication were you prescribed?  

[JetBay]

Anyone have a left bundle block? The left side of my heart is weak.  PVC's one every 10 heartbeats. Born with a bridge, which means main artery on the outside of the heart goes along for a while then goes in the heart and back out. Genetic defect. Otherwise healthy. Taking beta blocker, baby aspirin, fish oil.

[Soundrew]

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.

[ed34]

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.

[046]

Gracias :} will do ...