Troponin elevation in patients with various tachycardias and normal epicardial coronaries

Area of Science:

• Cardiology
• Clinical Medicine
• Biochemistry

Background:

• Troponin elevation is a key biomarker for acute coronary syndrome (ACS).
• However, elevated troponin without ischemic symptoms suggests alternative causes of myocardial necrosis.
• The specific mechanism of myocardial injury is not always identified by troponin levels alone.

Purpose of the Study:

• To investigate the correlation between cardiac arrhythmias and elevated troponin levels.
• To present a case series of patients with elevated troponin and normal coronary angiography.
• To emphasize the importance of considering non-ACS etiologies for troponin elevation.

Main Methods:

• Retrospective case series of seven patients (age 18-67).
• Patients presented with chest discomfort and elevated troponin I.
• All patients underwent coronary angiography, revealing normal epicardial coronary arteries.
• Included patients with supraventricular tachycardia, atrial fibrillation, and ventricular tachycardia.

Main Results:

• All seven patients exhibited elevated troponin I levels.
• Coronary angiography confirmed normal epicardial coronary arteries in all cases.
• Five patients had regular supraventricular tachycardia, one had atrial fibrillation, and one had ventricular tachycardia.
• No patients were hemodynamically unstable at presentation.

Conclusions:

• Cardiac arrhythmias, such as supraventricular and ventricular tachycardias, can cause myocardial necrosis leading to troponin elevation.
• Elevated troponin in the absence of ACS necessitates a thorough investigation for alternative causes like arrhythmias.
• Failure to identify non-ACS etiologies can result in delayed diagnosis and inappropriate treatment.