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Spuriously Elevated Cardiac Troponin in the Setting of Atypical Chest Pain Presentation: A Diagnostic Conundrum

Kamal M Kassem1, Mahboob Ali2, Naseem Ghazanfari2

  • 1Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio.

JACC. Case Reports
|July 28, 2021
PubMed

Insights

Heterophile antibodies can interfere with troponin tests, leading to falsely elevated results. This case highlights the importance of correlating laboratory findings with clinical presentation to avoid misdiagnosis of myocardial infarction.

Area of Science:

  • Clinical Chemistry
  • Immunology
  • Cardiology

Background:

  • Troponin testing is a cornerstone in diagnosing acute myocardial infarction.
  • Elevated troponin levels in patients with chest pain typically indicate cardiac injury.
  • Interference in laboratory assays can lead to inaccurate diagnostic conclusions.

Observation:

  • A 47-year-old woman presented with atypical chest pain.
  • Initial troponin levels were significantly elevated at 30.15 ng/dl.
  • Extensive diagnostic work-up ruled out acute myocardial infarction.

Findings:

  • The diagnostic work-up identified the presence of heterophile antibodies.
  • Heterophile antibodies are known to interfere with various immunoassays, including troponin tests.
  • This interference can cause falsely elevated troponin levels, mimicking myocardial infarction.

Implications:

  • Laboratory results must be interpreted within the complete clinical context.
  • Clinicians should consider potential assay interferences when test results are discordant with clinical findings.
  • Awareness of heterophile antibody interference is crucial for accurate diagnosis and appropriate patient management in cardiology.

Keywords:
ACS, acute coronary syndromeCK, creatine kinaseECG, electrocardiogramHAMA, human antimurine antibodyLHC, left-sided heart catheterizationcTn, cardiac troponincardiac magnetic resonancecomputed tomographyelectrocardiogramheterophile antibodiesleft-sided catheterizationtroponin

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