raised trope level

[Pete-Benje]

I was admitted to A&E and they did a blood test and found my trope level raised firstly what is trope and secondly they gave me 300 mil aspirin but the consultant on discharge did not put this on my prescription should I be on 300 mil or stay on 75 mil

[annpavitt250448]

The trope level indicates whether you might have had a heart attack. I believe it's standard practice to give 300ml of aspirin if you present with chest pains. I know I was given it when I ended up in A&E last year although my blood test levels were normal as was e.c.g although I was eventually diagnosed with angina and now take 75mg of aspirin each day.

[Tos92]

Hi Pete-Benje

I’m really sorry to hear you were admitted to A&E.

Troponin is a protein which is released after injury or damage to the heart due to a lack of oxygen. There are three types of troponin, Troponin I, Troponin T, and Troponin C. For myself, Troponin T has more commonly been measured when in hospital, and after my MINCOA last year.

It is thought that the higher the elevation in Troponin, the more likely the heart has sustained damage. For some, slightly elevated troponin numbers may be normal depending on their heart condition. Do you know which Troponin was tested for yourself and what your numbers were?

There is a link below if you wanted to read more into Troponin.

nbt.nhs.uk/sites/default/fi...

With the aspirin, I believe what’s happened is that when they suspect or have confirmed you’ve had a heart event, they will intervene and give you a higher dose of aspirin to prevent further heart damage, reduce chest pain, and to also help prevent blood clotting. I was given aspirin last year during my MINOCA however, this was not a part of my medication regime once leaving hospital. I have also been given doses of aspirin in A&E before as a precautionary measure when going in with chest pain. I am under the assumption that they would only increase the dose if they felt there was a long term need for it.

I hope you’ve been safely discharged and are at home now getting some much needed rest.

Let us know how you get on.

All the best.

Tos

[Musicl in reply to Tos92]

Hello Tos92, I have also been diagnosed with MINOCA since a suspected HA with raised troponin levels in 2020. I have yet to find out what this condition is, as the cardiologist treating me told me at my follow up that very little was known about MINOCA, so he could not tell me what it was. I have always been puzzled by his lack of knowledge. I would be very grateful if you could throw any light on this?

[Tos92 in reply to Musicl]

Hi Christine,

I’m sorry to hear about your MINOCA. It is under-recognised in the U.K. however, there are advancements that are being made to create more awareness about this condition.

I was in A&E 2 weeks ago, the doctor treating me had never heard of a MINOCA and had to Google it whilst I was sitting there. He said I was the first case he has ever come across.

My understanding of a MINOCA (myocardial infarction in non-obstructed coronary arteries) is that it is a medical condition in which a person experiences symptoms and lab findings, such as blood tests and ECGs for example are consistent with a heart attack (myocardial infarction) but without significant blockages in the coronary arteries.

During a typical heart attack (acute myocardial infarction), a coronary artery becomes blocked or significantly narrowed due to the buildup of plaque or a blood clot, leading to reduced blood flow to a portion of the heart muscle. This lack of blood flow causes damage to the heart tissue, resulting in a heart attack. These are more commonly known as STEMI’s (ST segment elevation myocardial infarction) or NSTEMI’s (non-ST elevation myocardial infarction).

In our case of having a MINOCA, despite experiencing a heart attack, the coronary angiogram shows no significant blockages or obstructions. I had an angiogram to confirm no blockages, I’m not sure if that was the case for you too. Sometimes, if there is a blockage, it might be subtle, or the cause of the heart attack may be related to other factors not involving plaque buildup, such as coronary artery spasms, small vessel disease, blood clotting disorders, or inflammation.

The exact cause of MINOCA can be challenging to determine, and it often requires additional testing beyond the standard coronary angiogram. Conditions like microvascular dysfunction or coronary artery spasms may be implicated in some cases. For myself, it was thought that my myocardial bridge, which is a congenital heart defect whereby the artery tunnels through the heart muscle instead of sitting on the surface spasmed. The spasm was confirmed during an angiogram.

Was the cause of your MINOCA investigated?

I have attached an article below which you might find useful in understanding MINOCA better.

ncbi.nlm.nih.gov/pmc/articl...

If I can help you in any way, feel free to send me a PM and I will try :).

If ever in doubt about your symptoms or medical condition, please contact your cardiologist or GP.

[Musicl in reply to Tos92]

Thank you for your informative reply Tos92,My angiogram showed no blockages, in fact they said that my blood vessels were in good condition at the time of the procedure. Please see my reply to Milkfairy on this page, which states all the details.

[Milkfairy Heart Star in reply to Musicl]

Hello,

I am sorry to hear about your heart attack.

A MINOCA, myocardial infarction non obstructive coronary arteries, is not a diagnosis in in itself, it doesn't say why a person has had a heart attack without blocked coronary arteries.

The term was adopted by a team in Australia, in particular Prof John Beltrame who also researches ischaemia non obstructive coronary arteries INOCA.

INOCA can lead to a MINOCA.

Microvascular dysfunction/ angina and coronary vasospasms / vasospastic angina are types of INOCA.

Other possible causes of MINOCAs are spontaneous coronary artery dissection SCAD or a small piece of plaque or a blood clot blocking a coronary artery or a mismatch of supply and demand which can happen in arrthymias, very high heartrate or lack of blood, following a haemorrhage.

MINOCA's are thought to be accountable for about 10% of heart attacks. This type of heart attack disproportionately effects women.

When I was admitted to hospital about 11 years ago with a suspected heart attack, I was told incorrectly that I couldn't have a heart attack or angina as my coronary arteries are unblocked.

My vasospastic angina was later diagnosed by a specialised angiogram when a chemical acetylcholine was injected into my coronary arteries.

I experienced spontaneous and induced coronary vasospasms.

It's important to know why you had a MINOCA as it's important to receive the appropriate treatment for the underlying cause and prevent another MINOCA.

Here's somemore articles about MINOCA

internationalheartspasmsall...

heartresearch.org.uk/nocad-...

The knowledge and research has certainly moved on about this type of heart attack and the possible causes.

I am aware that my local hospital in London includes MINOCA in their Acute Coronary Syndrome (Heart attack and unstable angina) pathway.

[Musicl in reply to Milkfairy]

Thank you for the information Milkfairy. Some very interesting reading here. The cardiologist did say at my follow up that it could be angina. I had an MRI three weeks after the HA and there had been no damage to the heart muscle. He said that it may have been caused by a blood clot, which had disappeared into a blood vessel after the blood thinners were given on arrival at the hospital. The doctor that I saw in A & E thought that it could have been an oesaphagial spasm, as that could mimic a HA. (I suffer from reflux), but when the blood tests came back from the lab, the troponin level was very high. I often wonder whether they mixed my bloods up with someone else's, as I had none of the classic signs of a HA, no sweating or shortness of breath, excepting a feeling of something pressing on my chest, which was similar to reflux. I did explain this to the cardiologist, but he said that they would still have to treat it as a HA. Maybe I have been taking these heart meds for nothing for over three years. Who knows? Sorry for the long drawn out info.

[Milkfairy Heart Star in reply to Musicl]

Oesophageal spasms wouldn't be responsible for an increase in your troponin blood levels though....

[Musicl in reply to Milkfairy]

No, but it could be possible that my blood test results were mixed up with someone else's. I felt so well after the discomfort in my chest had subsided, not poorly at all.

[Milkfairy Heart Star in reply to Musicl]

Possible but very unlikely that your blood tests would have been mixed-up.

Usually several blood tests are taken to see if the troponin blood levels rise and then fall which is a possible sign that an acute cardiac event has happened.

[Musicl in reply to Milkfairy]

Thank you for your reply. I am learning more from you than the cardiologist. I did not realise that more blood tests should be taken for the troponin. I thought that the sample taken in A & E was the only one necessary. At my follow up, when I mentioned my concerns to the cardiologist about the possibility of mix ups in the lab on the night that the test was done by the A & E doctor, he said that it was possible, but he didn't say that more samples would have been taken later on. (the A & E doctor took the troponin sample as the nurse had omitted to include the troponin sample when taking bloods earlier on my admission). I must say I don't have much faith in my cardiologist as there has been a lack of information throughout. I think it might be worth asking the hospital for my medical records to check what happened whilst I was in hospital. Thank you for being so helpful.

[Milkfairy Heart Star in reply to Musicl]

I was just about to suggest asking for a copy of your medical records. The easiest way is to contact the Patient Advisory Liaison Service PALS of the hospital concerned.

You can also ask for a second opinion from another Cardiologist.

I appreciate your concerns. Nobody wants to be given the incorrect diagnosis and treatment.

At the hospital I attend, the patients have a 'Patient Portal' where I can access all my blood tests. This includes the blood tests ordered by my GP.

A single high troponin blood level can't be taken in isolation.

It has to be intrepreted considering a person's symptoms and ECG findings.

[Musicl in reply to Milkfairy]

Thank you Milkfairy.I called 999. When the paramedics came, they performed an ECG and it was normal. In fact, one of the paramedics said that I wasn't presenting with any symptoms of HA, other than the pressure in my chest, which could have been indigestion. She said she had seen many HA patients and she didn't think it was a HA. She have me the option of being taken to hospital or not. The reason I wanted to go was to be checked over.I will take your advice about PALS and the second opinion and many thanks again.

[Pete-Benje in reply to Milkfairy]

Thank you

[Milkfairy Heart Star]

Hello,

Troponin is released into the blood stream when the heart muscle has been damaged or bruised.

Usually two blood samples are taken several hours apart to see if the troponin blood levels are rising or falling.

Troponin blood levels can be raised for a variety of heart conditions not just heart attacks eg, infection and inflammation due to myocarditis, pericarditis or endocarditis.

Kidney problems.

Blood clots such as pulmonary embolism.

Arrthymias, eg. atrial fibrillation and a high heart rate.

Heart Failure.

A lack of blood following a haemorrhage.

Aspirin is routinely given to patients suspected of having a cardiac event.

I am admitted often into hospital and my troponin blood levels are checked throughout my admission.

Have you been referred to a Cardiologist for a follow-up appointment?

Perhaps see your GP and discuss with them your latest A&E admission.

[Pete-Benje]

Thank you for your quick reply

[Hrty]

Hi, as others have said 300mg seems to be the standard initial dose. I was given that, along with a Clopidigrel "bomb" of 300mg when my HA was diagnosed last November. Been on75mg of each since.On discharge I was given a chest pain protocol to follow which says to take 300mg if I get to the point of ringing 999. I've also had to ring 111 a few times and they have told me to take 300mg whilst waiting for paramedics. Always a joy as they make me chew it 🤢.

[Sunnysummerdays]

Hi I take 75 mgs of aspirin,I wonder sometimes when I have angina or chest pain,that in an emergency,if waiting for an ambulance,if I needed, would it be ok to chew four of the 75 mgs of aspirin I have... just as a precaution.

[JeremiahObadiah in reply to Sunnysummerdays]

Probably something you should ask a good pharmacist or your Gp.

I would presume -no personal experience-you wouldn’t want to be taking a large dose regularly as it will not be good for your stomach etc so would need to know at what level of emergency/delay or wait for assistance it would be advisable and how best to take it/any other relevant things of which to be aware .

Someone who has first hand experience of this may chip in and have some far more pertinent knowledge and information .

[Harefieldfan]

hi Pete-Benje. Sorry you were admitted to hospital. Great advice here, though. I was given 300 mg when admitted and then put on a forever dose of 75 mg of soluble aspirin. I can’t take aspirin — hurts my stomach so I asked for and was given a suppository. Worth knowing about if anyone else has gastric problems. Good luck!