False-positive troponin elevation due to an immunoglobulin-G-cardiac troponin T complex: a case report
| Autor: | David Gaze, Paul Collinson, James Dargan, Sami Firoozi, Zaki Akhtar, Nesan Shanmugam |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Acute coronary syndrome Cardiomyopathy Case Reports 030204 cardiovascular system & hematology Chest pain Biochemistry Coronary artery disease 03 medical and health sciences 0302 clinical medicine Troponin complex Internal medicine Case report medicine Coronary heart disease (incl. Cardiac Intervention) 030212 general & internal medicine Myocardial infarction Falsely elevated troponin biology Troponin T business.industry medicine.disease Troponin biology.protein Cardiology Macrotroponin medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Heart Journal: Case Reports |
| ISSN: | 2514-2119 |
| DOI: | 10.1093/ehjcr/ytaa082 |
| Popis: | Background Troponin is a crucial biomarker for the diagnosis of an acute coronary syndrome (ACS). It rises in response to myocardial injury from significant acute myocardial ischaemia caused by obstructive coronary artery disease [‘classical’ myocardial infarction (MI)]. However, raised levels have also been noted in conditions not recognized as classical ACS. This may include MI with non-obstructed coronary arteries such as takotsubo cardiomyopathy and other acute or chronic conditions such as pulmonary embolus or chronic kidney disease. This is commonly labelled as a ‘falsely elevated’ troponin although there is some myocardial strain to explain the rise, such as an increase in cardiac oxygen demand. True ‘falsely elevated’ troponin, characterized by a persistent elevation in the absence of cardiac injury does occur and thought to be secondary to an immunoglobulin-troponin complex (macrotroponin). Case summary A 53-year-old gentleman with a background of diabetes, hypertension, hypercholesterolaemia, and hepatitis B was admitted with chest pain and persistently elevated cardiac troponin T (cTnT) levels. Investigations revealed unobstructed coronary arteries and a structurally normal, well-functioning heart. Subsequent biochemical analysis found the persistently elevated cTnT secondary to macrotroponin T. Discussion Macrotroponin, an immunoglobulin-troponin bound complex should be considered as a differential diagnosis when the biochemistry is not reflective of the clinical picture. Early recognition requires effective collaboration with the biochemistry laboratory for accurate diagnosis. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|