troponin in levels

[Lawnmower22]

hi all

What is classed as high troponin levels to be classed as a heart attack

[Hidden]

Hello

I am not sure what they class as a high level someone else will know the answer but when they suspect a heart attack they take the blood test and so many hours later they take another one if the levels come back higher than the first blood test then this indicates you have had a heart attack

ECG'S never showed my heart attacks up it was always the blood tests that did for some reason

Are you asking because you are concerned about your levels ?

Hope you have a nice weekend x

[Milkfairy Heart Star]

Depends on the reference levels the hospital uses.

My hospital says a high sensitivity Troponin T blood level 16ng/L for women, 32ng/L for men.

However Troponin blood levels can be raised for other reasons not just heart attacks. A raised troponin blood level doesn't necessarily mean a heart attack has happened.

A raised Troponin blood level has to be accompanied by chest pain and other symptoms, along with ECG changes to diagnose a heart attack.

Sometimes it's not always straightforward.

Some people have ' silent ' heart attacks. No ECG changes or chest pain.

[Milkfairy Heart Star]

Probably not.

I frequently have ST elevations and depressions, T wave inversions.

Sometimes raised troponins but so far the jury is still out about whether I have had a Myocardial Infarction non obstructive coronary arteries MINOCA.

I was once told by a very experienced Prof of Cardiology who has researched a new bio marker for heart damage.

' You can have a little bit of a heart attack but not be a little bit pregnant'.

For the ultimate definition of a Heart attack here's the 4th Universal Definition of a Myocardial Infarction see this link.

academic.oup.com/eurheartj/...

[Milkfairy Heart Star]

Here's a nice list to wet your appetite.

[RufusScamp]

All interesting info. I spent a week in hospital with a suspected HA, but they decided it wasn't. Never did find out what the problem was.

[Hidden]

I suggest you carry out a websearch for 'nhs troponin levels' or similar. This will throw up a number of references which NHS issue as guidance for health professionals.

One reference here suggests less than 14ng/l normal; 14-30ng/l probable MI ; greater than 30ng/l possible MI

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

However it appears it is not as simple as that, timing of samples is important, troponin values can be different in men and women, and other tests may be needed to confirm a MI.

[newstent in reply to Hidden]

I had a heart attack the night after having a stent fitted as the surgeon blocked off a side vessel with the stent. I went to A&E and my troponin levels were up around 600 at one point (as you say 30 is normal). Back at the cardio ward they put on my records that I was admitted with angina! The stent was redone and I'm feeling more normal now (6 months later). I think the diagnosis was to play down the seriousness of what had happened and avoid any blame for negligence.

[Hidden]

In an A&E setting the important indicator is whether the Troponin level is rising when someone is presenting with other physical symptoms of a heart attack. That is why if the Troponin level is above a certain threshold they will repeat the test some 3-4 hours later, take a good book. A one off test by itself is of limited use. It is rare for Troponin tests to be done outside of an A&E setting for that reason.

If you have are having or recently had a NSTEMI heart attack then the Troponin test is the only indicator because an ECG is not going to show anything.

[Qualipop in reply to Hidden]

I had an NSTEMI which was diagnosed by the paramedics on an ECG. It was over 5 hours before I got a troponin test. I had no chest pain, just severe indigestion and burping. Any pain was in my back. I was never told my troponin levels only that they confirmed what he paramedics had seen on the ECG. I was ignored after the A&E triage ( ie a nurse took my BP- nothing else) for 5 hours because I didn't have the supposedly obvious signs of a heart attack.

[Filipflop]

It’s not as easy as there being a threshold that anything above a certain level = MI.

You can have raised troponins for a lot of reasons ( pulmonary embolism, myocarditis, after running a marathon, takotsubo -broken heart syndrome).

It’s the clinical picture in context : nature and duration of chest pain, ECG findings, risk factors, angiogram findings or even cardiac mri findings aswell as troponin.

Some people have chronically raised troponins above the 99th percentile upper range limit. But it doesn’t necessarily mean they are having a heart attack.

More and more cardiac MRIs are being done which recategorise people who initially were thought to have heart attacks to other diagnoses described above.

I speak from personal experience ( myocarditis) and I’m also a doctor.

[Lawnmower22]

hi all

Thanks for all your valuable info it’s just the other day I had bad chest pains while I was out for a walk but forgot to take my gun with me ,when I got back in I took my gtn spray twice and went for a lie down didn’t sleep. Few hours later got up still with pain and took some more spay this time three lots of two over the relevant period but still no relieve so called the ambulance ,two hours later when they turned up they took an ecg etc and took me into hospital for blood tests several test later ecgs and a chest X-ray my blood test came back first tropin level was 12 and then hours later the second was 15 in the end the doctor said he thought it was just chest pain not my angina and discharged me that’s why I was asking about tropin levels

[Milkfairy Heart Star in reply to Lawnmower22]

Have you got a Cardiology appointment due soon?

If not perhaps go and see your GP to discuss what has happened.

I would suggest that your rise in troponin blood levels requires further investigation.

ahajournals.org/doi/full/10...

[Lawnmower22 in reply to Milkfairy]

hi milkfairy

I’m on the waiting list anyway for a heart bypass and a mitral valve at wythenshawe heart hospital

[Milkfairy Heart Star in reply to Lawnmower22]

I am glad to hear you are in 'the system'.

Have you made your Cardiologist aware of your trip to A&E?

It maybe be necessary to move you up, into the more urgent category on the waiting list.

[Zbignieva]

It is more about the increase in the levels of TNT from the first to second measurement. One previous consultant has told me that there is no definite MI unless the TNT is > 40 ng/ml.

If the trop is > 100 on the first measurement and the person hasn’t been in a situation that involved impact to the chest, I.e, road traffic accidents, it is probably 99% certain they have had an MI.

[Milkfairy Heart Star in reply to Zbignieva]

In the UK the units used are ng/L.

[Hidden in reply to Zbignieva]

In your example someone has either misunderstood or got the units wrong. 40ng/ml is equivalent to 40000ng/l . In the UK the threshold for a possible MI (requiring further investigation) appears to be typically below 40ng/l.

[Zbignieva in reply to Hidden]

I messed up the units as a result of half-assed posting. 🙄

The initial question was is there a level of Trop that definitely means a heart attack.

The investigation may mean repeating the Trop 6 h after a result that is > 14 to < 40 ng/L. If the second Trop has increased by 20%, the patient should be on the ACS (acute coronary syndrome) pathway.

If the initial Trop is > 40 ng/L, it is highly likely the person has had an MI, although not 100% definite.

The higher the initial troponin, the more likely there has been a heart attack, and the level of the troponin does correlate with heart muscle damage.

[Silvertail]

I think they measure it differently here in Aus. I have had four episodes of takotsubo cardiomyopathy, which has similar symptoms to a heart attack. Each time my troponins have been raised in the second test. Last time they said the second one was 77. The previous time was 58. I don't think that is drastically high but was high enough to put me in the CCU.

[Zbignieva in reply to Silvertail]

Exactly why we need the correct units. It is bad practice to use a number without the units but it is really common in hospitals.

[Milkfairy Heart Star in reply to Zbignieva]

It's also good practice to use the correct units for each country.

In your previous comment you have used ng/mls rather than ng/L which are the units used in the UK.

Are you based in the UK or US?

[Zbignieva in reply to Milkfairy]

I work in an NHS biochemistry lab so I should know better, it was lazy scanning of a previous post for the units.

[Milkfairy Heart Star in reply to Zbignieva]

Many a slip between cup and lip😊

[Fish4Info in reply to Milkfairy]

Hi, my old friend.

The discussion in this thread points to the real importance of quoting units. As a chemical engineer, this sort of stuff was drummed into us from our very first degree lectures (now 45 years ago ... seems like yesterday). Zbignieva has been super good for clarifying. As best I can tell, a troponin level of 30-40 ng/L is a probable MI - but diagnosis depends on other presenting symptoms, esp chest pain, but also exercise ECG etc.

In "my day", 16 years ago (since CABG), they used to talk of a rising troponin level (two tests, 6 or 12 hours apart) being over 1 as indicative of MI. Nobody ever quoted units. As best I can tell, this would have been nmol/m**3. Even then, "numbers" in other countries were different. Of course, if you know the units, you (well, more likely, me ;-)) can convert easily from one system to another.

30-40 ng/L = ~ 1 nmol/m**3

So, even here (UK), numbers change because of operational practice (eg in the NHS). It's all a bit confusing, especially as we have an international system of units (SI) which facilitates scientific and engineering communication.

Hope you are keeping well.

[Milkfairy Heart Star in reply to Fish4Info]

Hello!

It is very confusing and the goal posts keep moving!

We now live in the high sensitivity troponins world, along with the knowledge that in women the troponin blood levels are lower 14 or 16 ng/L when heart muscle damage can occur.

In my 10 years of having my troponin levels taken many many times, with an assessment of my ECGs, the way my results are interpreted has changed. I keep edging ever closer to a diagnosis of a heart attack rather than an acute cardiac event.

I am being told rather than my 'trop is normal' ' it's reassuring'

My careplan states the following when I am admitted.

" 12 lead ECG and routine bloods, including Troponin T and to be repeated to ensure no secondary rise"

Serial troponin blood levels need to be done, which are then intrepreted taking into account, medical history, any ECG changes and symptoms such as chest pain, breathlessness etc

Give it a few years and we might see a new cardiac injury biomarker, cMyC introduced into the NHS.

academic.oup.com/ehjacc/art...

I hope you are keeping well too 😊

[Fish4Info in reply to Milkfairy]

Yes, thanks. Really, the science is improving all the time, better to diagnose and treat what we have. Still, as Zbignieva points out, the correct units should be used ... so the nerds amongst us can work out whether what people say is reasonable ... and how it ties in with other information from around the world. 😀

[Milkfairy Heart Star in reply to Fish4Info]

Haha

Let's celebrate pedanticism.

Someone has to cross the Ts and dot the Is 🧐

[LesleyJ59]

I'm not entirely sure but when I had my HA the doctors at A&E were about to send me home with some antacids when my troponin level was found to be 200 - so straight onto the ward for me! I was told 20 was closer to normal.

[RailRover]

It is certainly confusing. Not to mention a little scary. I was told that if the troponin level was above 20 it indicated a heart attack. I was rather concerned to be shown the result later on a print out which read 24,000! Some heart attack!

It's a problem the world over with confusion over units. Aircraft have run out of fuel over the Atlantic due to fuel being loaded in metric rather than imperial measures.