79. Case Report: Recurrent Troponin Elevation – University of Washington


CardioNerds(Amit Goyal&Daniel Ambinder) join University of Washington cardiology fellows (Shannon McConnaughey, Betty Ashinne and Andrew Perry – host of the AP Cardiology podcast) for some tacos and beer at the water and discuss a puzzling case of recurrent troponin elevation. Dr. Kelly Branch provides the E-CPR and program director, Dr. Rosario Freeman, provides a message for applicants. Episode notes were developed by Johns Hopkins internal medicine resident Eunice Dugan with mentorship from University of Maryland cardiology fellowKaran Desai.

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Episode graphic by Dr. Carine Hamo

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Patient Summary

A female is her late 50s with past medical history of alcohol use disorder and intravenous drug usecomplicated by hepatitis Cpresented with generalized weakness and was found to have lower extremity fractures. Cardiology was consulted for pre-operative management.When obtaining a cardiac history, she reportedrare, intermittent, and non-anginal chest pain. She had no current chest pain or dyspnea. On chart review, she had multiple presentations over the past 3 years for various complaints – some were chest pain – during which she was found to have elevated troponinIvalues. Most of the elevations were in the 0.5 to 1ng/mLrange, but one time, her peak troponin was 32ng/mL.At one of those presentations, she had a TTE that showed septal wall motion abnormalities.She underwentcoronary angiographyon two occasions, which both showedproximal and mid-LAD calcifications, but nosignificantstenosis andshe was managed medically.

At the current presentation, her vitals were within normal limits and her exam did not show any cardiopulmonary abno…