Abstract
A 64-year-old African American male, with past medical history of hypertension, depression, and seizure disorder, presented with an episode of generalized tonic-clonic seizure. He was treated for seizures, and after 48 hours seizure-free, the patient started complaining of chest tightness and troponin levels were found to be 34.71 ng/mL. No evidence of myocardial infarction was found after extensive diagnostic workup, including cardiac catheterization. We suspect alternative causes of elevated troponin including post-seizure and transient takosubo cardiomyopathy.
Highlights
Markers of cardiac injury are used to diagnose myocardial infarction (MI) but problems arise in cases of falsely elevated markers leading to unnecessary interventions
To diagnose MI, cardiac troponin should rise and/or fall above the 99th percentile combined with evidence of myocardial ischemia as suggested by one of the following: 1) symptoms of myocardial ischemia; 2) new ischemic electrocardiographic changes; Review began 12/31/2020 Review ended 01/11/2021 Published 01/11/2021
Cardiac troponin is a universally accepted marker for cardiac injury and plays a crucial role in the diagnosis of acute myocardial infarction. These markers of cardiac injury are regulatory proteins controlling the interactions between actin and myosin mediated by calcium [1]
Summary
Markers of cardiac injury are used to diagnose myocardial infarction (MI) but problems arise in cases of falsely elevated markers leading to unnecessary interventions. The patient was initially treated with loading doses of aspirin and ticagrelor, heparin for acute coronary syndrome (ACS) protocol was started. He was given nitroglycerin sublingually for chest pain, which helped decrease the pain. The patient was given supportive therapy after cardiac catheterization His aspirin, ticagrelor, and heparin were discontinued and he was treated for his seizures with loading doses of Keppra and his troponin trended down to 35.5 ng/ml. Ticagrelor, and heparin were discontinued and he was treated for his seizures with loading doses of Keppra and his troponin trended down to 35.5 ng/ml He was discharged home symptom-free and was followed up after a week in the adult clinic. His troponin was back to
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