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.?"

[clover43210]

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.  

[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.

[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]

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.

[jfhbiff]

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.

[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]

Thanks curmudgen.  Very good point.

[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.

[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.

[curmudgen]

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?????

[jfhbiff]

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.  

[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

[ChatterAlly]

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

[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.

[georgesmom]

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???

[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.

[syralia]

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...

[bobby1967]

same with me.after a tooth infection and flu like symtoms 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

[Terrilentini]

This is interesting, after a horrible tooth infection and TMJ thanks to a negligent dentist I went to the ER bc my jaw started hurting bad. Still not sure if it was bc of the combination of tooth and TMJ.. And no pain in my chest just a burn on the skin that lasted just a few minutes. Anyway, Troponin was slightly elevated and remained that way for 4 days. After a series of test ekg, echo, CT scan blood work stress test the hospital threw their hands up in the air and stated they had no idea why my troponins remained in a wave like elevation. Followed up with Cardiologist and still no answers... Everyone is scratching their heads.

[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

[Pacergurl23]

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.

[kf14]

may i ask why you had to get a pacemaker?

[ed34]

Perhaps artery spasm?

[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.

[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.

[nicki13378]

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