|Year : 2016 | Volume
| Issue : 4 | Page : 503-504
Elevated troponin levels and typical chest pain: Is always acute coronary syndrome?
Altug Osken1, Tugba Kemaloglu Oz1, Gokturk Ipek1, Isil Atasoy1, Sennur Unal Dayi1, Regayip Zehir1, Selcuk Yaylaci2, Ercan Aydin3, Salih Sahinkus4
1 Cardiology Clinic, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
2 Department of Internal Medicine, Rize Findikli Guatr Research Center, Rize, Turkey
3 Department of Cardiology, Trabzon Vakfɝkebir State Hospital, Trabzon, Turkey
4 Department of Cardiology, Sakarya Akyazi State Hospital, Sakarya, Turkey
|Date of Web Publication||12-Jul-2016|
Cardiology Clinic, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Tibbiye Cad. 13, Haydarpasa, Kadikoy, 34846, Istanbul
Source of Support: None, Conflict of Interest: None
Aortic dissection is a fatal disease that must be considered in the differential diagnosis of chest pain. If the diagnosis cannot be made in early period, mortality is very high. Here, we present a case of aortic dissection, clinically mimicking acute coronary syndrome.
Keywords: Acute coronary syndrome, aortic dissection, chest pain
|How to cite this article:|
Osken A, Oz TK, Ipek G, Atasoy I, Dayi SU, Zehir R, Yaylaci S, Aydin E, Sahinkus S. Elevated troponin levels and typical chest pain: Is always acute coronary syndrome?. Med J DY Patil Univ 2016;9:503-4
| Introduction|| |
Aortic dissection is a relatively uncommon, though catastrophic illness often presenting with severe chest pain and acute hemodynamic compromise. Early and accurate diagnosis and treatment are crucial for survival. Although diagnosis is established as soon as possible on the emergency conditions, disease may have a high mortality rate. Many cardiovascular diseases are located in the differential diagnosis.
| Case Report|| |
A 55-year-old male patient was admitted to the Emergency Department with complaints of retrosternal typical chest pain at rest and continued intermittently for 12 h. He was a current smoker. He had no prior history of chronic illness, and he denied the usage of other legal or illegal medications such as drugs, and cocaine.
On physical examination, heart rate was 102/min, arterial blood pressure was 132/78 mmHg, and respiratory rate was 22/min. Cardiovascular auscultation revealed 2/6 diastolic decrescendo murmur on the right sternal border. Other systemic examinations were normal. Sinus tachycardia was present in the electrocardiogram (ECG), no ischemic changes were observed. His arrival troponin was 0.64 ng/ml (0:00-0:06). He has no significant feature in other laboratory parameters. Therefore, he was hospitalized as a preliminary diagnosis of non-ST elevation myocardial infarction. Medical treatment were held as clopidogrel 75 mg 1 × 1, ASA 300 mg 1 × 1, metoprolol 50 mg 2 × 1, atorvastatin 40 mg 1 × 1, and enoxaparin 0.8 SC 2 × 1. Six hours repeated cardiac troponin level was determined as 13.16 ng/ml. On the 2nd day of hospitalization, the patient was scheduled for early coronary invasive procedures. Echocardiographic evaluation was performed prior to coronary angiography and showed as normal left ventricular systolic function and no segmental wall motion abnormalities; whereas surprisingly, ascending aorta measured 4.8 cm in diameter, mild aortic regurgitation, and intimal flap dissection in the aortic lumen is compatible with view [Figure 1]. Immediately after, emergency abdominal + thorax computed tomography (CT) angiography for acute aortic dissection was taken. CT angiography revealed type 1 aortic dissection starting from the level of the aortic root bulbar and during the course showing the extent to all the aorta and iliac arteries [Figure 2]. He was consulted by cardiovascular surgery, and emergency operation decision was taken.
|Figure 1: Intimal flap dissection in the aortic lumen observed at echocardiographic evaluation|
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He underwent supracoronary aortic root replacement with a tube graft. On follow-up, inotropic support was administered due to the hemodynamic instability. The patient's hemodynamics did not improve with inotropic support and he was lost by not responding to cardiopulmonary resuscitation.
| Discussion|| |
In our case, we did not observe ischemic changes on the arrival to ECG. He has no severe chest and back pain which might suggest dissection on clinical history, so first, he was treated for acute coronary syndrome as a result of the determination of mildly elevated troponin levels. He was abandoned early coronary invasive procedure after the detailed echocardiographic evaluation, and he was diagnosed by aortic dissection and sent for emergency operation.
In patients who were admitted to the emergency services with the rise of troponin levels, making the rapid differential diagnosis of other cardiovascular diseases that can lead to positive troponin was very important.
| Conclusion|| |
With the help of clinical findings and imaging techniques, we will be able to prevent the placing of misdiagnosis and therefore, we can easily distinguish the diagnosis of aortic dissection for life-saving initiative interventions.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Mészáros I, Mórocz J, Szlávi J, Schmidt J, Tornóci L, Nagy L, et al.
Epidemiology and clinicopathology of aortic dissection. Chest 2000;117:1271-8.
Nienaber CA, Eagle KA. Aortic dissection: New frontiers in diagnosis and management: Part I: From etiology to diagnostic strategies. Circulation 2003;108:628-35.
[Figure 1], [Figure 2]