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 balooning 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 cute little mnemonic I used during my initial days as a Hospitalist to help me remember the non-ACS causes of Troponin elevation: DUH !! – NOT A STEMI
D – Dissection
U – Urgency (Hypertensive)
H – Heart Failure
N – Neuro (Head bleeds, Stroke)
O – Oxygen desaturation (hypoxia)
T – Tachyarrhythmias
A – Anemia, AKI
S – Sepsis
T – Takotsubo (broken heart syndrome) (like our patient above, caused by severe pain)!
E – Embolism (PE)
M – Myocarditis, Myocardial contusions (trauma, CPR, Electric shocks), Meds (Some Chemo)
I – Ingestion (Cocaine, Meth), Inhalation (Carbon Monoxide), Inflammation (Pericarditis)
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