52 year old man presenting with a 5/7 history of diffuse lower abdominal pain
He had been febrile for 3/7, had some nausea and vomiting and had not opened his bowels for 5/7.
He was otherwise well with no regular medications or past medical history
On examination he was febrile to 39 degrees celcius, tachycardic at 108 bpm with a peritonitic abdomen.
Surgeons were consulted and a CT scan organised.
Bloods had been taken before I reviewed the patient and were pending.
Prior to the CT scan the surgical registrar arrived to review the patient and had a look at the bloods which included a high sensitivity troponin (?!)
Unfortunately, this was elevated at 461, prompting the question above.
I was quite surprised by this reading and went back to reassess the patient.
He denied any chest pain, and was very fit and active with a good exercise tolerance and no risk factors.
Serial ECG's were performed (normal) and a repeat troponin was taken which was still elevated at 161.
The on call cardiologist was then consulted who advised that this was a false positive test and that we should disregard the troponin.
Like most of us I am still trying to get my head around the new HS troponin assays.
I was lucky enough to attend the SMACC conference this year and heard Louise Cullen and Rick Body speak on this issue.
They were both of the opinion that the HS troponin is very specific for heart damage (and shouldn't be raised at all if the heart is not affected) and if there were elevations it was due to an insult of some sort (though not necessarily ischaemia).
Based on that logic it would seem that the patient must have had a type 2 myocardial infarction....but I'm still quite sceptical that this occured in the patient given how fit and healthy he normally was.
Would be very keen to hear others thoughts and in particular if they had any information on this issue!
The patient subsequently had a CT that showed a perforated appendiceal abscess and went to OT where he was found to have 4 quadrant peritonitis with multiple adhesions.
He was discharged 6 days later and has been fine since.