In message <[log in to unmask]>, Sena, Salvador,
Ph.D. (DHSMAILUSERS) <[log in to unmask]> writes
><Dr. Michael Steiner wrote:
>
><TropT sensitive rapid test (Boehringer Mannheim 1621904) is increasingly
><used in the diagnostic workup of chest pain syndromes.
><I would appreciate to hear your experience with positive tests in
><situations other than acute coronary syndromes or renal disease which is
><well-known to cause positive readings.
>
>We are using this test and recently had some confusing results. A
>44-year-old female presented in our Emergency Department with "atypical
>chest pain" and nonspecific EKG changes, so, of course, they ordered serial
>cardiac markers. On presentation, her total CK = 124 U/L (ref <135), CK-MB
>(mass assay) = 3.4 ng/mL (ref <6.5) and cTnT = negative. Eight hours later,
>CK = 113, CK-MB = 7.7, relative index = 6.8 (ref <3.5), and cTnT = positive.
>Subsequent CKs were 97 (t=16h) and 66 (t=28h). AST was normal throughout
>the admission. A cardiac catheterization study showed normal coronary
>arteries. Unfortunately, by the time this case was brought to my
>attention, the patient had been discharged and it was too late to rescue any
>of the samples to repeat the cTnT, CK-MB, or perform other tests. Upon
>consulting the cardiologist, I learned that this patient has a history of
>systemic lupus erythematosus (SLE). I have heard about false positive
>troponin results in patients with rheumatoid factor. Could this possibly be
>related? What doesn't seem to fit with an interference is the small "bump"
>in the CK-MB and the change in cTnT from negative to positive. Any ideas?
>
>Sal Sena
>
>Salvador F. Sena, Ph.D.
>Associate Director, Clinical Chemistry
>Dept. of Pathology and Laboratory Medicine
>Danbury Hospital
>24 Hospital Avenue
>Danbury, CT 06810
>Phone: (203) 797-7705
>Fax: (203) 731-8061
>e-mail: [log in to unmask]
>
>* * * * * The opinions expressed herein are strictly my own and not those of
>my employer, spouse, friends, enemies, stockbroker, astrologer, personal
>fitness trainer, etc. * * * * *
>
>
>
>
The small rise in CK-MB but most imporatantly positice cTnT confirm a minor
myocardial injury.
cardiac disease and elevated cTnT does occur in SLE - I have 2 cases, one of
whom had a positive thallium scan.
Also, cTnT is up if there is myocarditis
--
Paul Collinson
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