Hypertroponinaemia - PowerPoint PPT Presentation
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Hypertroponinaemia
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Hypertroponinaemia Michael Stewart CT1 ACCS Case 1 64 year old male Known history of IHD 2x NSTEMI, UA Two hours of central chest pain, identical to previous MI ... – PowerPoint PPT presentation
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Title: Hypertroponinaemia
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Hypertroponinaemia
- Michael Stewart
- CT1 ACCS
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Case 1
- 64 year old male
- Known history of IHD 2x NSTEMI, UA
- Two hours of central chest pain, identical to
previous MI - ECG Lateral ST depression
- Trop T 0.07
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Case 2
- 72 year old male
- Presents with three hours central chest pain,
onset during dancing - Nausea, mildly dyspnoeic
- Ex-smoker hypertensive
- Not diabetic, no FH of IHD
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Case 2
- ECG shows dynamic inferior ST depression
- Pain eased after IV GTN and morphine with
resolution of ECG changes - Troponin 0.56
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Case 3
- 62 year old female
- Onset of palpitations and dyspnoea on waking
- GP found irregular pulse, rate 160
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Case 3
- Hypertensive no other significant co-morbidity
- ECG Fast AF, rate 170
- BP 100/60
- Pale, clammy, drowsy
- DC Cardioversion SR restored
- Troponin 0.13
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Troponin
- Component of cardiac and striated muscle
- Calcium binding initiates conformational change
to permit myosin to bind to actin filament - Myosin conformational cycling on actin acts as
molecular motor for muscle contraction - Cardiac Troponins are specific for cardiac
myocyte damage - Troponin is NOT specific for myocardial infarction
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PICI/SICI/NICI
- Primary Ischaemic Cardiac Injury
- Secondary Ischaemic Cardiac Injury
- Non-Ischaemic Cardiac Injury
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(No Transcript)
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PICI
- Coronary artery occlusion/stenosis by thrombotic
disease - STEMI/NSTEMI
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NSTEMI
- Any two of
- Typical chest pain
- Typical ECG changes
- Rise in cardiac enzymes
- New definition!
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2007 Universal Definition
- Troponin gt 99th centile of reference range
- (Locally agreed at Trop T gt 0.1)
- PLUS
- Ischaemic symptoms
- ECG changes
- Regional wall motion abnormality
- Loss of viable myocardium on imaging
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(No Transcript)
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SICI
- Secondary cause of coronary artery obstruction
- Embolic disease during PCI during CABG
- Coronary vasospasm or inflammation
- Primary vasculitides SLE
- Increased myocardial oxygen demand
- Tachyarrythmias prolonged exercise
sympathomimetic drugs heart failure PE
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(No Transcript)
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NICI
- Direct trauma
- Penetrating blunt surgical
- Myocarditis
- Infectious auto-immune drug/alcohol
inflammatory - Metabolic
- Renal failure multiple organ failure sepsis
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Cases
- Case 1 Typical chest pain, Trop T 0.07
- PICI, not criteria for NSTEMI
- Case 2 Typical chest pain, Trop T 0.56
- NSTEMI
- Case 3 Fast AF, no pain, Trop T 0.13
- SICI ( NICI )
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Questions?
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Summary
- Troponins are a sensitive marker of cardiac
myocyte damage - Not all cardiac myocyte damage represents acute
myocardial infarction - Primary, secondary, and non-ischaemic causes exist
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References
- Thygesen, Kristian, Alpert, Joseph S., White,
Harvey D., on behalf of the Joint
ESC/ACCF/AHA/WHF Task Force for the Redefinition
of Myocardial Infarction, Universal Definition
of Myocardial Infarction - J Am Coll Cardiol 2007 50 2173-2195
- Collinson, P O, Stubbs, P JAre troponins
confusing?Heart 2003 89 1285-1287 - http//www.trauma.org
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