A 68 year old gentleman fell from a ladder while setting up X-mas lights on his roof on a cold windy day and broke his hip. The pain was severe and it took him an hour to crawl back into his house and call for help. He underwent surgery for hip fracture next day and hip pain improved. After surgery he experienced chest discomfort. The on-call nurse-practitioner ordered an EKG & Troponin, saw T-wave inversions while Troponin was slightly elevated. Post-op Hemoglobin was down just one unit from 13 to 12. An urgent ECHO showed apical ballooning of the Left ventricle. What do we call this?
Troponin is a very sensitive diagnostic marker for Acute Myocardial Infarction. Are there other causes besides a classic heart attack that can increase Troponin levels? Plenty! Some can even mimic an Acute Coronary Syndrome. Here is a mnemonic I use to remember the non-ACS causes of Troponin elevation: “STEMI HOAX” :
S – Stroke, Subarachnoid bleeds
T – Tachyarrhythmias, Takotsubo (broken heart syndrome) (like our patient above, caused by severe pain)!
E – Embolism (PE)
M – Myocarditis & Pericarditis, Myocardial injury (trauma, CPR, Electric shocks)
I – Infections causing sepsis
H – Hypertension, Hypotension, Heart Failure
O – Oxygen Deficit (Hypoxia, CO & Cyanide Poisoning)
A – Aortic Dissection, Anemia, AKI/CKD
X – Think of ☠ the poison/toxins sign or X of toxins – (Cocaine/Meth/Decongestants & other meds)
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