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Discussion

Troponin question

pt with a post AAA, we did serial cardiac enzymes (every 8 hrs post surgery 3 times) and the first 2 were wnl, however the last one was elevated (troponin of 9.6, previous 1.5, CK and CKMB were very elevated as well). Surgeon was notified, but it didn't really seem to matter to him. I looked this up on google and couldn't find any real reason (other than cardiac tissue ischemia, renal failure--which the pt did have, or CHF) that would falsely elevate the troponin. EKG hadn't changed, BP was fine, everything else looked generally good.

my question is what would cause this random spike in the cardiac enzymes? both MDs i asked about this almost seemed unconcerned about this random spike, neither of them wanted to do anything about it. i'm just wondering if i missed something??

thanks!

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because the patient had surgery and most likely affected muscle. making the incision muscle has to be cut, also major blood vessel to and from the heart was mostly clamped off for periods of time.

This is the main reason you shouldn't obtain cardiac enzymes on a patient that has had cardiac-vascular surgery.

I kind of disagree, the time frame seems all wrong. If it was going to be positive as a result of the surgery you would see the bump in the first 4-6 hours, not 24 hours after the fact. I understand the the idea that you're basically causing myocardial ischemia when you're clamping to fix the AAA, but this far out?

I know both renal failure and CHF can cause bumps in troponin, but have yet to see it so bad without anything else. The other ideas I had is some sort of reperfusion damage, or maybe an NSTEMI related to the surgery (seen it before).

Am not claiming to know-it-all, but something seems odd here. Maybe I'm looking for zebras instead of horses.

Cheers,

Tom

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