Chest pain with raised troponin, ECG changes but normal coronary arteries

Abstract

SUMMARYA 65-year-old woman presented to A&E department, with acute onset central chest pain and dyspnoea. ECG showed dynamic T wave changes while 12 h troponin was elevated. A diagnosis of acute coronary syndrome was made and she underwent an inpatient coronary angiogram. Although her coronary arteries were normal, symptoms persisted and D-dimers were found to be elevated. This led to a CT pulmonary angiogram, which ruled out pulmonary embolism, but uncovered a large ascending aortic aneurysm with a contained leak. She was immediately transferred to regional cardiothoracic unit for urgent surgical intervention. This case report illustrates the importance of a good clinical history, physical examination and timely investigations. It also emphasises that not all chest pain events with elevated troponin level are due to acute coronary syndrome and that alternative diagnoses should still be considered. BACKGROUND

The Prognostic Significance of Elevated Cardiac Troponin in Non-Cardiac Medical Disorders. Pilot Study

“…Cardiac troponins were introduced in the year 2000 by the American and European guidelines to diagnose acute coronary syndromes caused by thromboembolic disease [6]. Their use has expanded to indicate myocardial injury caused by obstructive and nonobstructive coronary artery disease and they were found to carry prognostic significance [6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”