Elevated troponin, not necessarily myocardial infarction?
Doctor ha, my troponin is elevated, still think it is myocardial infarction, but angiography stricture is not serious, is this how to return a responsibility?Dr. Ha pinched his fingers and saw that the matter was not simple.Indeed, elevated troponin is often associated with a heart attack, most of which is caused by “blockage” of the coronary arteries, but some patients are not.In addition to coronary artery stenosis, these may lead to elevated troponin causes, and attention should be paid to prevention: 1.Coronary spasm coronary spasm: Similar to a coronary artery “cramp”, accounts for approximately 30% of non-obstructive coronary myocardial infarction.Symptoms: cold, satiety, emotional excitement, fatigue and staying up late are common inducements.Treatment: keep warm, don’t eat too much and keep your mood stable.In addition to these control triggers, drugs such as calcium antagonists (e.g. Diltiazem) may be selected to reduce coronary spasm.The prognosis is better than coronary stenosis.According to statistics, coronary angiography of about 90% of patients with acute myocardial infarction showed the presence of thrombosis obstructive coronary artery disease.However, 10% of patients showed no significant obstruction (stenosis < 30%) or mild stenosis (30% < stenosis < 50%) on angiography, giving rise to the fashionable medical term nonobstructive coronary myocardial infarction.2. Coronary microvascular disease Coronary microcirculation: refers to the vessels with a diameter of less than 0.5mm on coronary angiography.According to statistics, 80% blood flow of myocardium is involved in microcirculation.That is to say, even if there is narrowing of microvessels, they are not visible in coronary angiography, but not invisible.3. Myocarditis myocarditis: there are pathogenic bacteria infection, inflammatory infiltration of myocardial cells, so that their degeneration and necrosis, troponin rise.Symptoms: chest pain and other symptoms similar to acute myocardial infarction, but no obvious coronary artery obstruction on coronary angiography.Treatment: there is no specific treatment method at present, should emphasize bed rest, in order to reduce the burden of the heart, and in the light of arrhythmia, heart failure, cardiac shock and other symptomatic treatment.Stress cardiomyopathy stress cardiomyopathy: more often in women, most of the mood changes or fatigue and other stress factors.Symptoms: Clinical presentation resembles acute myocardial infarction with elevated troponin.However, no hemodynamic coronary stenosis was found in coronary angiography.Treatment: The prognosis is better than that of myocardial infarction because the contractile function of damaged myocardium is quickly restored.5. Other factors: Severe infections, use of cardiotoxic drugs (chemotherapeutic drugs), stroke, pulmonary embolism, end-stage renal disease and other non-coronary causes may be responsible.Treatment: For elevated troponin as a result of these conditions, treatment should be given for infections, kidney disease, etc.As can be seen, troponin elevation does not equal coronary angiographic stenosis. There are many reasons for troponin elevation, and it is not surprising that treatment varies greatly.(article | nan-nan zhao)