Troponin came back slightly elevated?

[peachychou123]

I've been having a bit of a POTS flare due to yet another viral infection. I only had a cold and sore throat, but my tachy was worse the last few days (120+ at rest, it was 140 in the hospital, when it's usually about 80) and I have been feeling a little more winded than usual with some chest pains, so I decided to go to the emergency room just to be on the safe side.

They did an EKG and bloods and my troponin came back at 0.02. The cutoff for normal is 0.034. So technically it's still below the threshold.  But I've heard troponin levels should ideally be at 0 in most people.

Apparently my troponin hasn't been 0. It always came back at 0.01 in my past blood tests. So it is always slightly elevated, though still low. No idea why. Perhaps the strain of chronic tachycardia?

But tonight scared me as I have had dozens of blood tests in the past, but suddenly it has doubled. The ER doctor did not seem concerned in the slightest and in her words 'a rise so small is like it never even happened.' I know there are other causes of elevation in troponin besides a heart attack, but these seem pretty serious i.e. PE, sepsis, etc.

I'm wondering if the sustained tachycardia has increased my troponin levels, and if any other POTS patients on here have experienced elevations in their cardiac biomarkers?

From a few medical journals I've read it seems that 'intense exercise' such as marathon running can cause small but remarkable rises in troponin levels in some people. I guess walking around with a heart rate of 160+ could possibly count as pretty intense exertion?

However, I'm not a doctor, so I don't want to jump to conclusions. Also, I'm only 25, and it seems most of the people in these exercise test studies were in their 40s and 50s.

Of course, my anxiety keeps making me think of worst case scenarios like viral myocarditis, or that maybe they took bloods too early and it's going to continue to elevate. 

But I'm trying to trust my doctors as I've developed a habit of questioning a lot of the things they say. Still confused as to why it was elevated though.

 

[Pistol]

I was 42 when I became symptomatic with POTS. Since then I had too-many-to-count ER visits and Observation hospital stays for POTS related symptoms, including chest pain, shortness-of-breath, syncope, seizures, tachycardia, hypertension. Even when I was MOST symptomatic - and thought I for sure was having a heart attack - my cardiac enzymes were always normal. This was despite having tachycardia and PVC's on my EKG as well as T-wave inversion ( an anomaly in the EKG that could indicate MI - but in my case is harmless because it is always there ). Ususally the doctors are looking for a change in the EKG along with a significant elevation in cardiac enzymes in order to determine any damage to the heart muscle. I would trust your ER doctor. Have they checked 3 sets of cardiac enzymes over 24 hours? 

[StayAtHomeMom]

If you are worried bring it up to your cardiologist and ask for a stress test or an echocardiogram. Anxiety over this issue is not going to help you with your POTS flare. I would try to trust them. Until they give you a reason not to, most doctors know what they are talking about when it comes to "normal" issues. Be well. 

[Clb75]

When I first got sick with Pots, I had an acute attack that landed me in the ER. My troponin was elevated and my ekg was abnormal. They told me tachycardia can cause elevated troponin. If you’ve been sick and more symptomatic maybe that caused a change. Perhaps you can follow up with your regular doctors who know you better than the ER doctor and ask their opinion for peace of mind. 

[Waylenzdaddy]

   I have had the condition for many years but never knew it. Hundreds of E R visits always said I had High BP and Anxiety.  They always said nothing was wrong with my heart. Finally at age 41, ai had a very bad attack and ended up in ER. 

 I was admitted and told I had a heart attack. Troponin was High, Stayed in for 5 days. After 5 days I was released and told I hadn't had a heart attack. These attacks continued and eventually I became bed ridden and was unable to even go to the bathroom. 

Still haven't received an official diagnosis but I have done loads of research for myself. I know I have pots... I am taking magnesium and Natto -Serra and most of the time it helps... sometimes like tonight I worry I may be having heart issues... Wish I could just pray it away.....

 

I am a single dad of a 4 year old, this is the last thing I need. Any suggestions would be a big help!!! I want to see my kid grow up!!!  Also, I hope something I wrote here will be of some help or comfort to you!!!

[Pistol]

4 hours ago, Waylenzdaddy said:

Still haven't received an official diagnosis but I have done loads of research for myself. I know I have pots

Hello @Waylenzdaddy - welcome to the forum! I am sorry you are dealing with all of this, seemingly on your own. If you don't mind me asking, what are your symptoms? In addition to the usual HR increase of 30 BPM upon standing there is a myriad of other symptoms that occur in POTS, and unfortunately most of us experience all of them. You mention that you had "an attack" that landed you in the ER but did not say what symptoms you had at the time. 

It is perfectly understandable that you worry about having an issue with your heart, especially if you have symptoms that are scary ( many of us do ). But as long as your physician has done all of the tests and everything comes back structurally normal you are OK. I have severe HPOTS and used to have frequent syncope, seizures, extremely high BP, chest pains, palpitations ... very scary symptoms. But all of my cardiac testing always came back completely normal, which was assuring. Have you had an echocardiogram, stress test, Tilt table test? These are all commonly ordered tests for POTS-like symptoms. Especially the TTT should give you an indication whether or not you have POTS. If you have not had on, did your doctor ever check your HR and BP lying, sitting and standing? That is called a "poor man's tilt", and often gives a clue towards POTS. 

It is always recommended that you keep a diary of your HR, BP and symptoms. It is not necessary to be overly occupied with your HR and BP, since it fluctuates from minute to minute for anyone. But to establish a "norm" by checking it twice a day at rest and then whenever you have symptoms can give a clue as to what is going on. 

I hope this is helpful. Please keep us posted on your progress!

 

[Gee]

I know it’s been a while since anyone posted on this thread, but I was desperately googling and this thread came up…I had COVID January 2021- after my 2 weeks of quarantine I went to the ER as my HR was resting at 160 and BP was 140/102…EKG was abnormal, I had a positive d dimer (blood clots), and my troponin was 0.07 (above the cutoff)…the kicker is- my troponin is still elevated (now 0.09) over a year later. I am dizzy all the time, high BP (which will drop suddenly- that’s fun), temperature change intolerance, developed peripheral neuropathy and reynauds- but none of my “-ologists” can pinpoint what’s wrong. I guess I’m just hoping to find answers and that maybe someone will see this and know why my troponin is still elevated and how to fix this? This is miserable- I hope everyone else is feeling a little better

[Pistol]

Hello @Gee - welcome to our forum! I had Covid last fall ( hospitalized for COVID pneumonia and respiratory failure ) and then developed a severe inflammatory reaction. My D-dimer was also extremely elevated, but no clots were found. I developed Long-COVID from it, which pretty much just is what I already dealt with before COVID ( from autonomic dysfunction ). With steroids and Antibiotics my D-Dimer and all the inflammatory markers slowly came down. 

The symptoms you describe in your post sound like Long-COVID. Why the troponin remains elevated I don't know. Have they checked you kidney functions? I know that COVID related complications CAN affect our kidneys. And that - in some cases - can affect the troponin levels. Other causes can be pulmonary embolism, but no doubt they checked for that, given the elevated D-Dimer. 

How are they treating your high BP's?

[MikeO]

Not sure how one gets diagnosed with long covid. But i have seen my white blood counts from the CBC tests elevated.

My troponin levels are posted below. Does not sing out to be long covid all i can say a slight increase IMO is not overwhelming concerning.

I did have a blood test looking for blood clots but was not a D-dimer and was negative .

Best.

 

[MikeO]

53 minutes ago, DysautonmiaMatt said:

Last year went to ER because of bad flare up. My WBC was slightly elevated in ER.  Day of discharge they were mid range - 2 days later. They did not give me any antibiotics.  ER Doc said they likely were high because of stress. 

@DysautonmiaMattI am sure you are right about stress causing some of this (especially ER visits). My WBC's do normalize eventually.