Skip to main content
×
Home
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 3
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    MacAlpin, Rex N. 2015. Some observations on and controversies about coronary arterial spasm. International Journal of Cardiology, Vol. 181, p. 389.


    Domico, Michele and Allen, Meredith 2016. Biomarkers in Pediatric Cardiac Critical Care. Pediatric Critical Care Medicine, Vol. 17, p. S215.


    Saenger, Amy K. and Haymond, Shannon 2015. Utilization of cardiac troponin assays in adult and pediatric populations: Guideline recommendations vs. reality. Clinical Biochemistry, Vol. 48, Issue. 18, p. 1213.


    ×

Elevated troponin levels in previously healthy children: value of diagnostic modalities and the importance of a drug screen

  • Poonam P. Thankavel (a1) (a2), Arshid Mir (a1) (a2) and Claudio Ramaciotti (a1) (a2)
  • DOI: http://dx.doi.org/10.1017/S1047951113000231
  • Published online: 05 March 2013
Abstract
Abstract

Background: Myocardial injury in previously healthy children is rare, with a wide range of aetiologies. It is increasingly being identified on the basis of elevated troponin levels during routine evaluation of cardiorespiratory symptoms. Establishing the aetiology remains challenging because of the lack of an accepted work-up algorithm. Our objective was to delineate the contribution of diagnostic modalities and troponin patterns towards the final diagnosis. Methods: A retrospective chart review of previously healthy patients admitted to the Pediatric Cardiology Service with myocardial injury was carried out. Data analysed included echocardiograms, electrocardiograms, cardiac catheterisations, magnetic resonance imaging, drug screen tests, troponin values, and final diagnosis. Results: A total of 32 patients were identified. The diagnoses were: myocarditis in 16 patients, vasospasm due to drug use in seven, myopericarditis in six, anomalous coronary artery origins in two, and Prinzmetal's angina in one patient. The electrocardiograms were abnormal in 27 of the 32 patients (84%), echocardiograms in 18 of the 32 patients (56%), cardiac magnetic resonance imaging in two of the four patients (50%), urine drug screen in five of the 25 patients (20%), and cardiac catheterisations in two of the 15 patients (13%). Conclusions: Myocarditis is the most common aetiology of myocardial injury in children. Clinical history remains the basic screening tool; drug screens help identify coronary vasospasms secondary to drug use (22% of our cohort). Patients with anomalous coronaries had exertional symptoms. Initial troponin levels and progression were not diagnostic or prognostic. Catheterisation is of limited value and did not change management. Magnetic resonance imaging with gadolinium enhancement is probably the most useful test when initial evaluation is not diagnostic.

Copyright
Corresponding author
Correspondence to: Dr P. P. Thankavel, MD, Department of Pediatrics, Division of Pediatric Cardiology, UT Southwestern Medical Center, Children's Medical Center of Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America. Tel: +1 214 456-2333; Fax: +1 214 456-8066; E-mail: poonam.punjwani@childrens.com
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

2.E Ohman , P Armstrong , R Christenson , et al. Cardiac troponin T levels for risk stratification in acute myocardial ischemia. GUSTO IIA investigators. N Engl J Med 1996; 335: 13331341.

3.DA Kane , DR Fulton , S Saleeb , J Zhou , JE Lock , RL Geggel . Needles in hay: chest pain as the presenting symptom in children with serious underlying cardiac pathology. Congenit Heart Dis 2010; 5: 366373.

4.A Mir , A Obafemi , A Young , C Kane . Myocardial infarction with use of the synthetic cannabinoid K2. Pediatrics 2011; 128: e1622e1627.

5.S Basnet , G Mander , R Nicolas . Coronary vasospasm in an adolescent resulting from marijuana use. Pediatr Cardiol 2009; 30: 543545.

6.KG Friedman , DA Kane , RH Rathod , et al. Management of pediatric chest pain using a standardized assessment and management plan. Pediatrics 2011; 128: 239245.

7.JL Brown , DA Hirsh , WT Mahle . Use of troponin as a screen for chest pain in the pediatric emergency department. Pediatr Cardiol 2012; 33: 337342.

8.H Childs , M Friedrich . Cardiovascular magnetic resonance imaging in myocarditis. Prog Cardiovasc Dis 2011; 54: 266275.

9.M Imazio , R Trinchero . Myopericarditis: etiology, management, and prognosis. Int J Cardiol 2008; 127: 1726.

11.D Kobayashi , S Aggarwal , A Kheiwa , N Shah . Myopericarditis in children: elevated troponin I level does not predict outcome. Pediatr Cardiol 2012; 33: 10401045.

12.H Mahrholdt , C Goedecke , A Wagner , et al. Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation 2004; 109: 12501258.

14.G Camastra , L Cacciotti . Late enhancement detected by cardiac magnetic resonance imaging in acute myocarditis mimicking myocardial infarction: location patterns and lack of correlation with systolic function. J Cardiovasc Med 2007; 8: 10291033.

15.MA Mittleman , RA Lewis , M Maclure , et al. Triggering myocardial infarction by marijuana. Circulation 2001; 103: 28052809.

16.A Aryana , MA Williams . Marijuana as a trigger of cardiovascular events: speculation or scientific certainty? Int J Cardiol 2007; 118: 141144.

17.P Thankavel , P Brown , H Carron , C Ramaciotti . Imaging the coronary artery: is it really normal? How to avoid common echocardiographic pitfalls. Circ Cardiovasc Imaging 2012; 5: 415418.

20.SS Kim , MH Jeong , HK Kim , et al. Long-term clinical course of patients with isolated myocardial bridge. Circ J 2010; 74: 538543.

21.M Martin , E Romero Tarin , LH Luyando , J Rondan , C Morales . Myocardial bridging: light in the tunnel. Int J Cardiovasc Imaging 2009; 25: 555557.

22.DC Xiang , ZH Gong , JX He , YJ Ruan , ZH Xie . Characteristics of stress tests and symptoms in patients with myocardial bridge and coronary artery spasm. Coron Artery Dis 2009; 20: 2731.

23.J Laissy , F Hyafil , LJ Feldman , et al. Differentiating acute myocardial infarction from myocarditis: diagnostic value of early- and delayed-perfusion cardiac MR imaging. Radiology 2005; 237: 7582.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords: