Cardiologist not sure if I had heart attack but stented due to troponin-i level high

[tamilank]

Hi All,

I had severe chest pain in the 3rd week of Jan 2019. BP ok, heart beat ok, ECG OK but troponin level was 400, so I have been told I had a heart attack. Angiogram report showed a block (75%) in a diagonal artery which is very tiny and minor so they didn't stent and was given few medicines like aspirin and other blood thinning tablets and discharged.

Second time I had severe chest pain again after 3 weeks, as before everything was ok but troponin level was 390, so I have been told I had a second heart attack. This time I was sent to another hospital for angiogram where they had stented in the tiny artery found in the first angiogram report.

Third time, I had pain again after 9 days and as before everything was ok but troponin level was 360. This time, they told me you may not have heart attack. Cardiologist not sure why troponin level has not come down, which usually come down within a week.

They think my troponin level may be in the same range (350 to 400) in my blood always. Now they have a doubt whether I had a heart attack in the first place.

My blood has been sent to another hospital for further diagnosis.

I am very much stressed now with the question whether I had the heart attack and also very worried that even the cardiologist not able to diagnose why troponin level has not come down?

Has anyone faced similar situation please?

[Milkfairy Heart Star]

Vasospastic angina - Coronary artery spasm can cause a rise in troponin levels. It can take upto 2 weeks for your troponin levels to return to normal

It is also possible to have a heart attack without any severe blockages.

Myocardial infarction non obstructive coronary arteries MINOCA.

A coronary spasm causes a temporary narrowing of the blood vessel. The usual treatment is with Calcium channel blockers and GTN.

A Heart attack can be difficult to diagnose. Usually ECG changes ST elevation or ST depressions or T wave inversions and flattening with a rise and then fall of troponin levels also the way the wall of heart moves changes.

With pain in the chest, left arm, neck, jaw, upper back. Feeling breathless, lightheaded, sick and very tired.

Some people have no symptoms at all.

[sturon]

What a worrying time it must be. I am sorry I can't offer you any explanation but what I can say is, feel reassured for the future. You have had angiogram which are largely normal, so your future heart health looks good. As 'Milkfairy' says there may be other explanations like coronary artery spasm.

What is important is you get the cardiologist to be clear with you, and your GP, about what they will 'label' this as. This may affect you insurance (Life, travel, and possibly driving) in the future. Be clear with your GP what they would put on any medical certificate to an insurance company in the very unlikely event of you ever making a claim. Declare what you agree with them and ensure they record what you agree in your medical records.

I hope they get to the bottom of this for you and wish you a long and health life ahead.

[Nicky3]

Hi,

You must feel very worried and being in limbo as to your diagnosis is not easy too. I have gone through times when they are unsure what to do and you can't move on. I believe a Cardiac MRI perfusion scan (think that's what it's called) will show if you have heart damage. Therefore, it would definitively rule if you had a heart attack or not as well as give other valuable information. I had one and it showed my heart damage proving my heart attack as I was in limbo diagnosis wise. Plus I was fighting my insurers regarding Critical illness. They paid out straight away after that.

They need to check what your base levels are and as Milkfairy says spasms can cause a rise in tropinins. I have the same condition as her, spasms of the arteries and MVD. My arteries are clear (had 2 angiograms) a very severe spasm caused my HA. It is very unusual to cause a HA I am told (but probably under diagnosed).

Good luck you are the best advocate for your health. Put yourself first by looking after your needs and rest when your body tells you.