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[Typical laboratory constellation of a non-ST-segment elevation myocardial infarction in polymyositis]

J T Bittenbring1, C-H Chen, P Fries

  • 1Innere Medizin der Universitätskliniken des Saarlandes Homburg/Saar. bizzl1@aol.com

Deutsche Medizinische Wochenschrift (1946)
|December 2, 2010
PubMed

Insights

Elevated troponin T in patients with polymyositis may not indicate myocardial infarction. Measuring troponin I is crucial for accurately assessing cardiac involvement in inflammatory myopathies.

Area of Science:

  • Cardiology
  • Rheumatology
  • Clinical Chemistry

Background:

  • A hypertensive crisis prompted admission in an 80-year-old woman with elevated cardiac enzymes (CK, CK-MB, troponin T), initially treated as non-ST segment elevation myocardial infarction.
  • Extensive cardiovascular investigations including echocardiography, coronary angiography, and MRI ruled out a cardiac etiology for the elevated biomarkers.

Observation:

  • The patient was diagnosed with long-standing polymyositis, specifically Mi-2 antibody-positive.
  • Elevated troponin T levels were attributed to the release of muscle enzymes from regenerating muscle tissue due to chronic inflammatory damage.

Findings:

  • Troponin I, a cardiomyocyte-specific marker, can differentiate between cardiac and non-cardiac sources of elevated CK, CK-MB, and troponin T.
  • Treatment with prednisone led to a gradual reduction in polymyositis activity.

Implications:

  • Measuring troponin I is recommended for patients with inflammatory myositis/myopathies to accurately diagnose and evaluate potential cardiac involvement.
  • This approach aids in distinguishing true myocardial injury from elevations caused by inflammatory muscle conditions, improving diagnostic accuracy.
Abstract

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