Hi I am just back from hospital after what the doctors are calling a heart attack and I am describing as a cardiac event - essentially I had chest pain after falling into a manure bog, sinking, being unable to get out, calling the emergency services, and suffering hypothermia (last Sunday). Precautionary tests showed high troponin, with repeated measures showing the same. Apart from a few blood pressure spikes (some caused by medication) other tests were normal (heart rate, ECGs, angiogram). While I have a few more tests to have my feeling is that this was a stress-induced event as I am normally fit and healthy, go on long walks (10km - 15km). I am interested to learn about the reasons for raised troponin other than heart pathology.
Cardiac Event After Trauma - What is ... - British Heart Fou...
Cardiac Event After Trauma - What is the Research?
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LiziJ
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Crumbs Liz, you don't do things by half do you!!! I think what happened to you could cause anyone's heart to kick off! Lucky that you had your mobile phone with you.
I know very little about heart attacks, so can't help you re the troponin. However, super fit people, that exercise and eat all the right things still have heart attacks. Annoying isn't it.
Wishing you well.
Jean
Thanks. It was very lucky I had my phone as I did leave it behind but decided to go back for it. Also really good that the phone was so robust being immersed and covered in muck at the same time (iPhone). It was amazing really - I had police, fire, ambulance and helicopter out finding me. Apparently it was treated as a drowning and I was being advised on the phone to stay still and not try to get out as I could sink further in. It is no wonder my heart reacted really.
Hello LiziJWelcome to the forum.
That was an experience!
It is possible to experience a heart attack without obstructed coronary arteries, known as Myocardial infarction non obstructive coronary arteries MINOCA.
The common causes are coronary vasospasms, microvascular dysfunction, a blood clot forming or a mismatch in the supply of blood to the heart when needed.
The common triggers for coronary vasospasms, vasospastic angina are stress and the cold.
Another cause of a rise in tropinin is a condition that is due to an acute response to stress.
Takostubo Cardiomyopathy.
This tends to effect women more than men, and most people recover over time.
cardiomyopathy.org/about-ca...
Other reasons for a rise in tropinin are trauma, infections such myocarditis, kidney disease, arrthymias, pulmonary embolism and extreme exercise.
I suggest you discuss with your Cardiologist the cause of your cardiac event. It's important so you receive the appropriate treatment and follow up care.
Hello Milkfairy thanks for your message and explanations of the various ways that troponin can be hight and yet there not be obstructed coronary arteries. I am yet to have an echocardiogram and coronary MRI but these are expected to be normal but it does sound like an acute stress reaction and hopefully the symptoms and raised troponin enzyme can undergo a form of rebalancing. I will have a look at Takostubo cardiopathy too. So thanks again for this information and I will of course discuss everything with my cardiologist too.
It's common to think you have to have obstructed coronary arteries to have angina or a heart.
About 10% of heart attacks occur in people without obstructed coronary arteries.
Hopefully you echocardiogram and Cardiac MRI will help guide your Cardiologist.
Kristin1812Heart Star
So good you got the help you needed. But what an experience you’ve had!You can of course search Wikipedia just like I can. But I did note the following quote
‘Strenuous endurance exercise such as marathons or triathlons can lead to increased troponin levels in up to one-third of subjects, but it is not linked to adverse health effects’.
I was looking for something that suggested such a stressful event as you experienced might raise troponin, but didn’t signal the damage of a heart attack. Though the quote focusses more on physical stress, I would imagine your wait, trying to keep head above slurry, warm, calm and breathe! was pretty tiring and stressful.
Do you think it was it equivalent to a marathon?
See Takostubo Cardiomyopathy cardiomyopathy.org/about-ca...
With the caveat that I’m not medically qualified in the slightest. My understanding is that to some extent, it’ll depend on the degree of elevation; although not true in every case, very high levels of troponin are usually indicative of heart damage. However, troponin elevation is not unique to heart attacks and there are actually a large number of conditions throughout the body that can result in ‘troponin leakage’. We also know that prolonged tachycardia can lead to lower level elevation; about 50% of all episodes of SVT (a type of common, relatively benign but extremely fast arrhythmia) result in raised troponin after an episode without the person having sustained any damage to the heart. I’m guessing your heart rate was probably pretty high under the circumstances.
This paper is a bit full on and technical, but the table included towards the top lists all the conditions where elevated troponin is a relatively common occurrence:
acc.org/latest-in-cardiolog...
It does say that troponin should be assessed in the context of the person’s symptoms, not as a stand-alone, but silent heart attacks are also a thing. So…🤷♂️
LiziJ• in reply to
Thank you I will take a look. While my cardiologist is looking after me I want to understand possible processes too. My understanding is that my troponin did not do as expected in a full blown heart attack (i.e. be elevated and then continuing to rocket) but it was high (260) and then increased (to 360) and then didn't increase further, although I don't know if it has decreased. I will look at the paper, thanks.
Not at all. My longest walk is only 10 miles whereas a marathon is 26 miles, and on that morning specifically I had only walked about 2 miles before the accident. Of course this is walking too and not power walking or speed walking either, I don't get breathless so it doesn't seem exercise-related but could be stress-related from the accident which is actually my thinking. I don't know if the manure contents or chemicals may have had an effect as well. Still, grateful to be home now and recovering and not have any actual damage that has so far been detected to my heart.
Hello Liz sounds like you have had a rough time.
I had an MI back in 1982 and it still shows on an ECG. As others have said we are not medically trained we only offer our own information on our journey through Heart related issues.
It would be interesting to hear if anyone else has experienced a Heart Attack without it being identified on an ECG/Angiogram or even had a Heart Attack that didn't cause any muscle damage. Sure your Cardiologist will give you more information over time .
Regards
Thanks Prada, the cardiologist I saw yesterday did agree with me that it might have been a stress related event but they are still calling it a heart attack and treating me for Acute Cardiac Syndrome pending further investigations. I agree that it will be interesting to hear what other say about the only indicator of heart attack so far being elevated troponin.
A very experienced Cardiologist once said to me when they were debating whether I had had a heart attack some years ago, before they knew I had coronary vasospasms.
'You can have a little bit of a heart attack but you cannot be a little bit pregnant '
hi,I've had 2standby angiogram 2stents and 2nd time re stented cos my lad artery didn't like the thought of being unblocked after so many apparently obvious years of being 100%blocked.i had echocardiogram and ct scan but nothing was detected as being wrong.all in 2 years.so had mri in November just had results last week which finally show that I've had a mild heart attack at some stage...never had elevated trip levels that I've been told about and the scariest part is that I've never experienced chest pain,not at all...i eat well n healthy I don't drink or smoke.though I used to smoke..which obviously hasn't helped at all..no caffeine i.e. tea coffee or fizzy etc since I've been poorly I'm not a active as I was..i used to go for long hard walks swim cycle etc..but never had chest pain..im due to go in again for another standby angiogram in just under3 weeks to check the silly artery hasn't squashed the stents again... it's actually quite rubbish but yes...ive had a heart attack without having symptoms or detection on anything but the mri scan...also might be of interest that it was meant to be a stress mri but the meds were just being put in my veins and it felt like my head was going to explode so they couldn't put the meds in to see how my heart handles the stress.....so I don't have a clue what's gonna happen next...which if anyone may know the answer from experience I would be grateful to hear....xxDebxx
So glad you’re okay Liz, sounds like you went through an awful experience! A few years ago I had a really prolonged svt episode and needed hospital treatment. My troponin levels were quite high as a result.
Hope you don’t have any more misadventures.
It could have been stress cardiomyopathy, a way they confirm that is they use cardiac MRI with gadolinium, to look for scarring if it’s Takotsubo that resolved there should minimal or no scarring. Too much adrenaline is toxic to cardiomyocytes, they can be stunned and release troponin but necrosis seldom happens sciencedirect.com/science/a...
Should get tested for stress cardiomyopathy since treatment isn’t the same as CAD. Same goes if it was a vassospasm.
I hope you feel better.
Ignoranus, Stress Cardiomyopathy is better known as Takotsubo syndrome/cardiomyopathy.
bhf.org.uk/what-we-do/news-...
The left side of the heart can be distorted so it looks like a Japanese octopus pot, hence the name.
This can be seen during an angiogram or echocardiogram.
Coronary vasospasms can raise a person's troponins blood levels too, if prolonged.
Vasospastic angina is diagnosed by using acetylcholine during an angiogram to provoke the vasospasms. Occasionally a vasospasm can be seen during a normal angiogram.
This testing is only available in a few centres in the UK.
bhf.org.uk/informationsuppo...
Do you have a lived experience of Takostubo syndrome or vasospastic angina?
My angiogram was normal. In fact the Cath lab consultant said my arteries were in perfect condition. I am due to have an echocardiogram and cardiac MRI. I have no experience of any heart problems.
Indeed, I called it Takotsubo in my second line but find it easier to spell stress cardiomyopathy. And yes, apical ballooning is what it’s named for but there are cases where it doesn’t happen pubmed.ncbi.nlm.nih.gov/181...
I suffered chloroform poisoning due to a work place accident, had detectable troponin, and SVT and yes a cardiac MRI with contrast was part of the work up I got (albeit months later). The MRI showed no sign of scarring which brings us back to the topic: if you run the heart too hard troponin can be released without causing permanent damage.
Thanks. All useful information. I just have to wait for extra tests now but realise it may take a few minths. The cardiologist suggested 3-4.
I agree Takostubo is a challenge to spell😊
Are you aware of Kounis syndrome?
An allergic reaction causingcoronary vasospasms.
For sure and it terrified me since I have raynaud's syndrome, and drugs like vancomycin provoked that, and when I had those tachycardia episodes I felt like I was going to faint. Which is why I’m glad they did a full work up. Really wasn’t anything wrong but tachycardia and metoprolol fixed that.
It’s funny but after I stopped being terrified I got much better.
It does sound unpleasant.
Interesting your comment about beta blockers.
I live with Raynauds, migraine and coronary vasospasms.
Beta blockers are usually contraindicated in these conditions.
I ended up in hospital with much worse coronary vasospasms when prescribed beta blockers before my confirmed diagnosis.
Thanks that is really helpful and it is my feeling that what I had was a stress event. I am going to have a cardiac MRI so hopefully after that and the echocardiogram everything will be clear. I will read the article too. Thanks for the link.
Hi Lizi,
That must have been a seriously scary time for you stuck in that bog. Glad you got out okay.
Just to add to what Milkfairy has said about Takotsubo syndrome, please have a look at this site: takotsubo.net/
And with great trepidation 😀 I'd correct one thing Milkfairy says: the left side of the heart takes the shape of an octopus trapping pot rather than one for lobsters!
Thanks. That looks like a really good resource. I will explore it.
Well spotted! Yes, I meant to say octopus!
Thank you 😊
If something is furry, meows and chases mice, then the chances are it's a cat. Calling it a furry 4 legged feline won't change the fact that it is still a cat.
If you've had raised tropinin levels and the doctors tell you that you've had a heart attack, then it's a heart attack.
One of the worst things with events like this is that they are a huge shock. In my experience, the ptsd from HA's is rarely addressed. Ptsd comes in many forms and denial of the 'incident' can be a part of it.
When I did cardiac rehab, we had a lady there who really struggled to accept she'd had a heart attack as it hadn't been what she expected it to be.
So I guess, what I'm saying is that it sounds like you may be in denial.
I really hope this helps you. Be gentle with yourself and kind and give yourself a bit of time. But also try to accept the diagnosis 😉👍.
Snowerbm,
The problem can be that a heart attack can be difficult to diagnose at times.
When I have a severe episode of coronary vasospasms, I will have ECG changes, ST elevations and depressions, T wave inversions.
A raised Troponin and lots of chest pain. Looks and feels like heart attack, acute coronary syndrome or unstable angina.
When I first went to hospital in 2012, the Cardiologists couldn't decide whether I had had a heart attack. The jury is still out.
A person experiencing Takotsubo syndrome will have ECG changes, raised tropinin and chest pain. It looks very much like a heart attack.
• in reply toMilkfairy
I understand. I was replying based on the limited information in the post and my personal experience.
Thank you Snoweybm. There is a clear point to what you are saying. In my case though the only thing that makes it look like a heart attack are raised Troponin levels and there are other explanations for that. Blood pressure, heart rate, ECGs and angiogram have all been normal. I am on heart medication and having further tests but other than Troponin there is no evidence so far that I have had a heart attack. I am more than happy to accept a heart attack diagnosis if evidence comes to light. However shock and PTSD are important. I am a psychotherapist so work with these in my practice.
After a 10km power walk carrying an extra 6k in a backpack the previous day then a personal trainer workout in the morning I had massive heart attack end of July last year. Cardiac arrest the works. I was extremely fit and active prior to the event which left me with AFib. And I needed further treatment. Now have permanent muscle damage and reduced ejection fraction. I haven’t any risk factors, normal cholesterol, 59yrs, a healthy size 12. It was a blood clot causing it other arteries are fine. Women can have heart attacks for different reasons than men and they can present differently as well. Look up the differences between gender and the heart. X
I am sorry to hear that you experienced this. We think we are fit but I have known for a long time about the balance between fitness and over-exertion and I imagine that there were no signs for you, no unusual discomfort, before the cardiac event happened. I feel relatively confident in my case, though, that it was the hypothermia and survival stress that were the precipitating factors. Essentially my heart complained that it couldn't cope with the stress of the event.
Goodness LiziJ. Your story takes me back to the time I slid (gracefully I hope) into what might be described as a manure bog. It was between the gate posts of a field I needed to go through. I had convinced myself I could tiptoe round the edge but apparently not. I wasn't far in and upright but it was a hell of a job to get myself out. I was spurred on by the thought that if I called the fire brigade they would be dining out on the story for quite a while.
As for the heart attack side of things I'm reminded of the account one of the cardiologists at my local hospital told of his own myocardial infarction which was diagnosed not by him but his secretary. He had vomited a bit but that was the only sign of something amiss. A colleague suggested he test his troponin levels which came back much higher than yours at 1800 ng/L. An angiogram revealed perfect main coronary arteries but the damage was shown up by the cardiac MRI. He put the event down to stress of the job.
I do wish you well.
I had to go back to the hospital today as I was having pins and needles pain in my left arm. All was fine and actually Troponin was back to normal levels with the blood test. Is this what usually happens after a heart attack or does it indicate no heart attack happens I wonder…
I am sorry to hear you ended up back in hospital.
Troponin levels usually fall to much lower levels after a heart attack.
Just as an aside, I experience numbness, pains and needles in the left side of my face and arm with my episodes of vasospastic angina.
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