How can a blood test for heart attack be determined without a Troponin test?

[ian_md]

I'm no expert, but isn't a Troponin test required to signal a heart attack? I've unfortunately had 3 blood tests for suspected attacks now and each time the doc says the results are clear, yet I've a copy of them and not once do they include the Troponin test. Are they looking at a different marker? My only reassurance to this punishing discomfort and pain is knowing I've not had an attack but I'm starting to question the results. Help!

[Hidden]

Hi,When I had my HA 11 weeks ago I had several blood tests and elevated cardio enzymes were present. I was told that these are only present if you have had a heart attack, or as they said " your heart has suffered a trauma" training levels were measured and indicated I had had a heart attack. I hope you get ro the bottom of this.

[ian_md in reply to Hidden]

Thank you, I have no such reference in my blood tests. I'm attaching them as a reply.

[ian_md]

Blood results

Blood results

[ian_md in reply to ian_md]

Bloods

Blood results

[Hidden]

If those are definitely all the bloods they undertook, then no, you haven’t had your troponin checked, and my understanding is that you can’t rule out a heart attack without checking your troponin. You do also have a wonky bilirubin level and platelet count, though, so may need to follow up on those with your GP unless you’re already aware of them. It may be worth double checking at the same time if they did troponin or not - the GP should be able to tell you definitively. It’s always possible that you just weren’t given the result.

[ian_md in reply to Hidden]

Thanks, I think that is all they tested but will ask. They assured me it wasn't a heart attack as bloods haven't shown anything, plus they said my ECG would have a clear indication but I'm now questioning this too!

[Hidden in reply to ian_md]

As I understand it, you can have a normal ecg but have had (or be having) a heart attack or other acute coronary syndrome, the same as you can have raised troponin and not have had a heart attack. The two in combination are considered definitive, but not necessarily independently, even if the ecg is done during an episode of chest pain. The ecg sensitivity for picking up previous heart attacks is also pretty low, meaning it won’t always pick historical attacks up if there wasn’t significant muscle damage. Again, though, I think this may be a conversation best had with your GP, as there are many other possibilities for chest pain other than your heart. But whatever it is, it definitely warrants further investigation.

[Milkfairy Heart Star in reply to Hidden]

Just to be even more confusing you can have a raised Troponin levels and ECG changes and have other conditions. Eg Takstubso syndrome, myocarditis, Pulmonary embolism and following a severe coronary artery spasm.

I have had slightly raised Troponin levels and ST elevations and depressions but as yet not thought to have had a heart attack rather coronary vasospasms.

[Hidden in reply to Milkfairy]

Extremely useful piece of information there, Milkfairy, thank you for that - over the last few years I’ve learnt that very few things in medicine are ever actually definitive. Certainly not as definitive as some doctors would like to believe or otherwise make out, anyway!

[Milkfairy Heart Star in reply to Hidden]

Medicine is an art!

One lovely Cardiology Prof said to me, you can have a little bit of a heart attack but never be a little bit pregnant!

[Hidden in reply to Milkfairy]

Love it 😂

[Gjkas]

Hi Ian. I'm not a Doctor but I know that if you've had a heart attack your troponine levels are raised when they do a blood test. They do another blood test a few hours later and if it's still raised, then you have definitely had a Heart Attack, or are having one. But if the troponin level have dropped when they do the 2nd blood test, then it's questionable if you have had a Heart Attack. You can have an ECG that seems to be normal. Then 5 minutes later you can have a Heart Attack. An ECG is not always right. But a Raised Troponin from 2 blood tests a few hours apart is a SURE sign of a Heart Attack..

It doesn't look as if they checked your troponin out..But they should have done..

Hope that you can sort your problem out soon. Good Luck. 👍

[Hidden]

My Troponin-T test results are not on my discharge letter either just like yours all the other stuff like creatine is on there.

You will have probably had Troponin-T test done but it is done with a different assay from a general blood test which is looking for a whole load of different things and done by a machine with a single sample. Nowadays a high sensitivity Troponin test is done which is not the same as tests done by a blood lab for Troponin.

Part of the issue I understand is that the "Troponin level" depends on the actual test kit used in that hospital, each has its own threshold values so having a letter with a "result" on is not of much use to any other hospital or even the same hospital if they change the test kit they use a few months later. Everything on your general blood tests is useful information to retain to be able to compare weeks, months or years later, the result of the "Troponin test" is not.

What matters is whether your Troponin level is above the threshold of the test kit being used and if so is it rising 3 hours later.

If you present at an NHS A&E with chest pain an ECG and Troponin tests are the first things that are done, always.

[ian_md in reply to Hidden]

This is interesting, I'm speaking with the doctor this morning. All I know is I had an ECG and then 3 bottles of bloods taken to produce the results above, hopefully the doctor will see more information.

[Hidden]

The discharge letter might mention in passing something like Troponin level not elevated. If they took 3 samples I would suggest one was for the general bloods, one for Troponin and one for HIV.

(Maybe it is a London hospital thing but in the two A&E's I've been in this year there was a discrete notice saying that all patients having blood taken will be screened for HIV unless they see this sign and choose to opt out).

[Dolphin14]

Serial cardiac enzymes can determine heart muscle damage. I don't see that you had those done either.

[richard_jw]

When I have been to A&E with chest pains, the first thing they do is an ECG. I had a major MI last august, and the paramedics did an ECG at home. They told me that I was having a serious heart attack (a STEMI). There was no doubt so they took me straight into a cath. lab. So assuming someone has given you an ECG, it seems unlikely that you have had a STEMI.

When I turned up at A&E after discharge basically because I was frightened, and the GP told me to) they did an ECG then a blood test. Each time they said they were testing for Troponin as a marker. They did so twice separated by 2 hours and sent me home.

Troponin is the marker used to determine whether you are having a heart attack.

Troponin levels drop after some time (don't know how long) and I don't know in your case what the sequence of events was. For instance A&E will do their stuff, and the tests you have may not be those which A&E did.

Fact of the matter is that you are getting chest pains which may well be angina, pericarditis or something else.

You may well have an assigned cardiologist who you can contact via their secretary. They should be able to phone you and explain

[ian_md]

Thank you for all the comments. Spoke to the doctor this morning who went through all my A&E results and on both occasions, my Troponin came back as 'less than 2' so wasn't considered worth further investigation (I don't know if that is 2.0, 0.2 or 0.02; doctors speak a different language to me). I guess the mission to find out what my tight chest, numb left arm and constant feeling of shakyness is then continues...

[Marcathon]

Hi there Ianit's a tricky one, I'm no medical expert and certainly wasn't six months ago before my HA, aged 45, totally unexpected, fit and running many marathons in 2020. when I felt ill and went to A&E my HR, BP and ECG and most bloods were all totally normal, so they assumed all was ok EXCEPT thankfully they did a troponin test which showed it at 50,000 when they expect it to come back at 9-12 ! so they did a second one and it showed the same thing, so clearly that's what I had had. subsequently when I've had chest pains and gone through A&E they have run these tests and each time checked for troponin and thankfully come back normal each time. One of these occasions I had spoken to the GP who got me down to the surgery for BP, HR and ECG test but they were inconclusive so sent me to A&E anyway. So I would definitely always push for a troponin test personally. I was told they are only available by going through A&E.

I don't know if this is just for Southampton where I was treated and is a major cardiology centre of expertise, or for all A&Es.

I didn't want to waste anyone's time of course but each time I went in they said that I must never feel like that, that if you have a history of heart attack and you have chest pains you should get it checked out through A&E.

I hope that helps a bit and good luck.

Marc

[ian_md in reply to Marcathon]

Thank you. I've not myself had any past HA's or heart related problems and on both visits to A&E the Troponin has come back less than 2, which I believe is non existent. I cannot wait for my consultant appointment next week!