[Interpretation of elevated serum troponin levels in end stage renal disease - case 2/2010]
Ferruh Artunc1, Michael Haap, Nils Heyne
1Medizinische Universitätsklinik Tübingen, Abteilung für Endokrinologie, Diabetologie, Nephrologie, Angiologie und Klinische Chemie. ferruh.artunc@med.uni-tuebingen.de
History And Admission Findings:
We report on a female patient with rheumatoid arthritis and end-stage renal-disease following AA-amyloidosis who presented with chest pain to the emergency department.
Investigations:
ECG showed no signs of ischemia, echocardiography revealed a concentric left ventricular hypertrophy with increased texture. Serum concentration of troponin I was mildly elevated whereas creatine kinase (CK)/ CK-MB were normal.
Diagnosis, Treatment And Course:
The chief complaints resolved spontaneously and there was no change in the serum troponin-I and CK/CK-MB concentrations. Coronary heart disease was ruled out by angiography and cardiac involvement of the underlying AA-amyloidosis was diagnosed. After one month, the patient suffered from a syncope complicated by a pelvic ring fracture with hemorrhagic shock and declined chronic dialysis treatment.
Conclusion:
Patients with end-stage renal disease may exhibit a persisting elevation of serum troponin concentration reflecting the high burden of cardiovascular disease. Myocardial infarction can be distinguished by the lack of increase in serial tests.
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