Increased Troponin Levels With PE May Be Tied to Concurrent Myocardial Ischemia

High troponin levels in patients with pulmonary embolism (PE) may be evidence of concurrent myocardial ischemia, according to study results presented at the American College of Cardiology (ACC) 2023 conference, held from March 4 to 6, 2023, in New Orleans, Louisiana.

Researchers reported their findings of a 61-year-old woman with obesity who presented with acute, sharp, substernal, nonpleuritic chest pain that radiated to her left jaw when she walked. She had taken a trans-Atlantic flight 4 days before presentation, and her vital signs and examination showed no abnormalities.

The patient’s high-sensitivity troponin-T level was 1195 ng/L at 0 hours and 1946 ng/L at 3 hours. Electrocardiography results demonstrated normal sinus rhythm and nonspecific inferior and anterolateral ST changes. Chest computed tomography scan showed multiple segmental and subsegmental PEs. Transthoracic echocardiography results showed basal-to-mid inferolateral and anterolateral hypokinesis with mildly reduced left ventricular ejection fraction.

The woman underwent urgent coronary angiography, and distal thrombotic occlusion of a right posterolateral ventricular branch was observed with otherwise angiographically normal arteries. An interatrial septal aneurysm with bidirectional shunting was shown on transesophageal echocardiography. The patient began therapeutic anticoagulation and standard medical therapy for heart failure.

“This patient presented with simultaneous PE and acute coronary syndrome because of paradoxical embolism,” conclude the researchers. “Though PE may cause a modest elevation in troponin, higher levels may indicate concurrent myocardial ischemia and warrant further investigation.”