Troponin positivity in AVNRT: A panic reaction and its mechanism.

Here is an uncommon story of a patient with palpitation,SVT , Troponin +ve, and suspected ACS. Palpitation in ER ⇒ {Tachycardia +Troponin positive ≠ ACS} Mechanism of troponin elevation following any SVT At high heart rates (>200) myocardium is subjected to non-Ischemic mechanical strain & squeeze. Minute amounts of Troponin is let out like a myocardial juice into the circulation (Like atrial natriuretic peptide release which causes polyuria during AVNRT) Tropinin releases have been shown to correlate with both heart rate and duration of ST depression (Subendocardial strain /AVRT left lateral pathways) Short diastole induced low coronary perfusion pressure and a true transient (but insignificant) Ischemia Finally, SVT (especially in the elderly) is a natural “exercise stress test” equivalent, ST depression with Troponin positivity is a true marker of significant epicardial CAD ECG courtesy https://litfl.com/st-segment-ecg-library/ Significance False alarm of ACS is the most important issue. (Except one study which showed a different conclusion Chow GV, Prognostic significance of cardiac troponin I level in hospitalized patients presenting with supraventricular tachycardia. Medicine (Baltimore) 2010;89:141–148. doi: 10.1097/MD.0b013e3181dddb3b. [PubMed] Note: If AVNRT occurs with aberrancy, or AVRT presents as antidromic tachycardia with a wide qrs tachycardia the confounding effect is perfect as it can no way be differentiated from true Ischemic V...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Uncategorized avnrt avrt af biomarkers in tachycardia cpk troponin in avrt false positive troponin in avnrt svt troponin t troponin 1 Source Type: blogs