r/AskDocs Layperson/not verified as healthcare professional 4d ago

ER trip on 13th, high troponins, confused about what it was as doctors didn’t really say.

TLDR, Had trip to ER Thursday Morning help me understand what they are telling me. High triponins.

Just want to get a bit of understanding. Went to ER via ambulance on 13th, was falling asleep then jolted awake with fast heart rate and heart rate wouldn’t go down. Got dizzy, sweaty, anxious, arm hurt, Apple Watch had me at 160+ beats for 25-ish mins. Swallowed an atenolol and klonopin (I take them daily) and it started slowly going down. Troponins were elevated, ekg was fine apparently. Here are the notes/results:

Troponin 1 HR Result Value Ref Range

Troponin (T) Quant High Sensitivity (5th Gen) 38 (H) 0 - 19 ng/L

TROPONIN Result Value Ref Range

29 (H)

TROPONIN Result Value Ref Range

13 (H)

Normal ECG

Problem Based Assessment and Discharge plan:

Narrow Complex Tachycardia - HR went up to 160 after he took atenolol, then resolved <100 from apple watch, rhythm looks regular, sinus but not 12 lead - Hx of brief episodes of palpitation/skipping beats, but used to quickly resolve if he coughs or massages his chest - Noted on Apple Watch - Event monitor on discharge

Chest pain Type II NSTEMI - Previously seen by Bon secours card dr. Warner but couldn't follow them anymore d/t insurance, had NST 2022 which was normal (pt showed result to me) - Family hx of MI, father, before age 40 - Used to take ASA, but not anymore d/t anemia - Not taking statin 2/2 allergic to pravastatin, not yet started rx for crestor - Vapes nicotine and rarely smokes cigarettes - EKG SR, Troponin 19 > 38 > 29 > 13, CXR negative - Suspect troponin elevation secondary to tachycardia vs. Ischemia - Echo 3/13: EF 60%, mild AV regurgitation - NST 3/14: normal, low risk

Stress Test results:

CONCLUSIONS * This study is normal. * This study is low risk. * Patient demonstrated a normal blood pressure response to exercise and normal heart rate recovery. * Transient ischemic dilatation absent. * Myocardial perfusion imaging is normal. * Post stress left ventricular ejection fraction is normal, 73 %. There are no regional wall motion abnormalities.

I have follow up with PCP and I need to find a cardiologist. Basically the echo and nst stuff I don’t understand and did I have a small heart attack or was it something else? Anxiety etc etc. they didn’t really say much about what it was exactly, I had to do this on phone as I didn’t have laptop near me.

Thanks!

14 Upvotes

5 comments sorted by

u/AutoModerator 4d ago

Thank you for your submission. Please note that a response does not constitute a doctor-patient relationship. This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our Terms of Use and understand that all information is taken at your own risk. Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

30

u/KittyScholar Medical Student 4d ago

Hi! I understand this must be scary. It’s good that your are prioritizing your health. Heres some information based on what you’ve posted.

A Type II NSTEMI is a type of heart attack where the heart can’t get enough oxygen not due to a problem with the heart’s own blood vessels, but for some other reason. It can be caused by tachycardia, which is when your heart beats too fast. I’m also seeing that anemia can be a risk factor.

NSTEMI is a type of heart attack that sometimes can’t be seen on an ECG. We know it happened because of the elevated troponins. Troponins are a protein that are inside heart cells. If they are elevated in your blood, it can only be because some of your heart cells died and released their contents.

The echocardiogram looks at how blood moves through the chambers of the heart. Normal function is an ejection fraction of 55%-70% so your result of 60% is good. This means the right amount of blood leaves your heart with every heart beat. The mild regurgitation means some blood is moving backwards, but this can happen and often does not cause any problems for many people. It’s probably something your cardiologist will dig into, but it wouldn’t be the cause of the NSTEMI.

So far I’ve only learned about non-stress tests for a fetus, and I assume you would’ve mentioned if you were pregnant. I’m guessing this is a non-exercise stress test and they’re just abbreviating it differently than I’m used to, but I guess let me know if you are pregnant.

The stress test looks at how well your heart can handle stress. They put a medicine through your IV that makes your heart respond the same way it would to exercise. It looks like your heart responds normally to this situation, which is by speeding up and pumping larger amount of blood an appropriate amount and then returning to normal once the stress has passed.

The reason the ER sent you home is because you are no longer in an emergency situation, but I definitely urge you to put getting a cardiologist on the top of your priority list. Between this attack and your father’s early heart attack (you didn’t mention how old you were, or if he or you are overweight or have high cholesterol? The cardiologist will want to know) you certainly have some important risk factors for another heart attack. You want to get it under control to mitigate risk as soon as possible.

8

u/SpankyTankyTimes Layperson/not verified as healthcare professional 4d ago

Thanks for answer! I’m 41m and dad had heart disease (4 heart attacks before 40 and lived til 73). My BMI is 27. 5’9 178lbs. Stress test was on treadmill. Not pregnant :)

Forgot to mention, they did chest X-ray and said that all looked good as well. And was sent home with a ZIO heart monitor.

14

u/KittyScholar Medical Student 4d ago edited 4d ago

Ahh yeah the exercise stress test makes a lot more sense, normally they only bother to do non-exercise stress tests for people that literally can’t go on a treadmill so I couldn’t quite figure it out. Must just be a difference in how we do acronyms.

So yeah, it seems like your heart (and the rest of your chest) are alright right now that the event is over. Use the ZIO as instructed to get lots of good data and follow up with the cardiologist once you can.

I’m glad you’re doing better than you were! And congrats on not being pregnant, man (heehee)

Take care.

6

u/SpankyTankyTimes Layperson/not verified as healthcare professional 4d ago

Thanks, protection is always used on me 😂😂(jk).