Troponin I Levels in Patients with Preeclampsia

Joyal, Dominique; Leya, Ferdinand; Koh, Megan; Besinger, Richard E.; Ramana, Ravi K.; Kahn, Steven E.; Jeske, Walter; Lewis, Bruce E.; Steen, Lowell; Mestril, Ruben; Arab, Dinesh

doi:10.1016/j.amjmed.2006.05.068

Cited by 50 publications

(30 citation statements)

References 16 publications

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“…There are no data to suggest that placental production of cTnI occurs and its specificity for cardiac muscle, as distinct from vascular smooth muscle, would militate against this possibility. In addition, we have reported no significant immunoreactivity for cTnI in human placental homogenates 5,6,23 .…”

Section: Discussionmentioning

confidence: 77%

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Cardiac troponins and oxidative stress markers in non-pregnant, pregnant and preeclampsia women

Pasupathi¹,

Manivannan²,

Manivannan³

et al. 2010

Bangladesh Med Res Counc Bull

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Free radicals play an important role in the pathogenesis of tissue damage in many clinical disorders, including atherosclerosis. This study was to investigate lipids and oxidative stress markers among women with 50 healthy non-pregnant compare with 50 healthy pregnant and 50 pregnancy-induced hypertensive subjects and correlate with cardiac troponin I (cTnI) and troponin T (cTnT). The level of plasma thiobarbituric acid reactive substances (TBARS), cTnI and cTnT levels significantly increase in pregnancy-induced hypertension compare with other groups. The level of lipids significantly altered in pregnancy-induced hypertension. Conversely, the activities of both enzymatic and non-enzymatic antioxidants were significantly decreased in pregnancy-induced hypertension compared to nonpregnant and healthy pregnant. Our data suggest that there is an imbalance between lipoperoxidation and antioxidants levels during pregnancy and preeclampsia. Serum cTnI and cTnT are elevated in women with pregnancy-induced hypertension indicating some degree of cardiac myofibrillar damage and cardiac dysfunction.

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Section: Discussionmentioning

confidence: 77%

“…Cardiac troponin contains an immunologically distinct Nterminus amino acid chain not expressed in skeletal isoforms. Cardiac troponin is released into the circulation in response to myocardial injury and has been shown to be one of the most sensitive and specific markers of myocardial damage both in ischemic and non-ischemic condition 5,6 .…”

mentioning

confidence: 99%

Cardiac troponins and oxidative stress markers in non-pregnant, pregnant and preeclampsia women

Pasupathi¹,

Manivannan²,

Manivannan³

et al. 2010

Bangladesh Med Res Counc Bull

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“…Indeed, cTnI values measured during gestational hypertension and preeclampsia show higher values in the latter [7]. But it is also evident that not all patients with preeclampsia demonstrate a significant rise in cTnI or whether cTnI levels increase during the course of the disease and are affected by the increasing severity of the disease [16,19]. Perhaps other pathologies related to severe preeclampsia may help to explain these findings.…”

Section: Discussionmentioning

confidence: 99%

Interpretation of Cardiac Enzymes in Hypertensive Disorders of Pregnancy: Seeking Diagnostic Clarity

Mathur

2017

J Med Cases

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A markedly raised cardiac troponin I (cTnI) in a patient is always alarming and usually suggests significant myocardial damage, as seen in acute myocardial infarction. There are, however, other circumstances where raised cTnI may be encountered without overt myocardial necrosis. Prior studies have evaluated serum cTnI levels in preeclampsia, eclampsia and normotensive healthy pregnant women in order to define their diagnostic value. Other factors, such as altered renal function, as in preeclampsia, may also affect the serum troponin levels, leading to misdiagnosis and incorrect management. We highlight the diagnostic and management difficulties faced in the management of our patient who presented with raised cTnI following multiple eclamptic fits, without other signs of an acute cardiac event.

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“…6 Troponin levels have also been studied during pregnancy and are generally felt to remain in the normal range, but they may rise to the upper limit of normal. 7,8 Like BNP, troponin levels are higher in women with hypertensive disorders of pregnancy, particularly pre-eclampsia.…”

Section: Information About a Real Patient Is Presented In Stages (Bolmentioning

confidence: 99%

Caesarian Dissection

et al. 2013

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Forward Information about a real patient is presented in stages (boldface type) to an expert clinician (Dr Nandita S. Scott), who responds to the information, sharing her reasoning with the reader (regular type). A discussion by the authors follows.A 35-year-old woman, G2P1, with a history of Hashimoto's thyroiditis, vitiligo, and gestational diabetes mellitus presented in the 30th week of pregnancy with premature labor. She was admitted to the obstetrics service for monitoring and tocolytic therapy. On hospital day 2, the patient complained of chest heaviness and left arm discomfort, but her assessment was confounded by pain secondary to frequent uterine contractions. On hospital day 3, fetal monitoring disclosed a nonreassuring fetal heart rate pattern, prompting transfer to the operating room for urgent Caesarian section. A viable female infant was delivered, but the immediate postoperative course was complicated by acute dyspnea, coughing, and hypoxia.Dr Nandita S. Scott: Dyspnea is quite common during pregnancy as a result of physiological changes including weight gain, dilutional anemia of pregnancy, and progesterone-induced hyperventilation. This can make the distinction between pathology and normal dyspnea of pregnancy difficult. In contrast, hypoxia during pregnancy is never normal. The cardiac causes of hypoxia in the peripartum period can be broadly separated into 2 categories: congestive heart failure from preexisting cardiac conditions (eg, cardiomyopathy, valvular disease, or congenital heart disease) or congestive heart failure attributable to pregnancy-induced cardiac conditions (eg, peripartum cardiomyopathy or acute ischemic events). Pulmonary causes such as pulmonary embolism and amniotic fluid embolism also need to be considered.Pregnancy poses a large hemodynamic burden on the cardiovascular system. A 30% to 50% rise in blood volume and cardiac output, increase in heart rate, reduction in systemic vascular resistance resulting from the low-resistance placental unit, physiological anemia, and positional reduction in cardiac output attributable to compression of the inferior vena cava all contribute to stress the heart. 1 Pregnancy may therefore unmask a preexisting cardiac condition that was unknown before conception. At delivery, this hemodynamic burden increases further as a result of the autotranfusion of uteroplacental blood, tachycardia from pain, and the loss of the low-resistance placental unit. Consequently, the cardiovascular adaptations of pregnancy remain clinically relevant after delivery of the fetus. Indeed, it may be months before the circulation fully returns to normal.This patient had no preexisting cardiac conditions that we are aware of. On hospital day 2 she developed chest pain, which suggests a possible ischemic cause for her symptoms. Peripartum cardiomyopathy is a less likely explanation for her symptoms, because this patient was only 30 weeks pregnant and peripartum cardiomyopathy occurs most often in the last month of pregnancy and the first 5 months after delivery.I...

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Troponin I Levels in Patients with Preeclampsia

Cited by 50 publications

References 16 publications

Cardiac troponins and oxidative stress markers in non-pregnant, pregnant and preeclampsia women

Cardiac troponins and oxidative stress markers in non-pregnant, pregnant and preeclampsia women

Interpretation of Cardiac Enzymes in Hypertensive Disorders of Pregnancy: Seeking Diagnostic Clarity

Caesarian Dissection

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