Falls-associated elevation of troponin level in an older woman with normal coronary arteries

A 75-year old woman with no history of ischaemic heart disease sustained a fall with scalp laceration. She had no chest pain. Troponin I was found to be high on admission and remained so for one day. Computed tomographic coronary angiogram was normal. She was discharged on low dose aspirin. The issue of non-ischaemic elevation of troponin is discussed. Correspondence to: Dr James KH Luk, Department of Medicine and Geriatrics, Fung Yiu King Hospital, 9 Sandy Bay Road, Pokfulam, Hong Kong. Email: [email protected] no intracranial haemorrhage or skull fracture. In the ward, she was noted to be very nervous with a blood pressure of 200/100 mm Hg and a heart rate of 100 beats per minute. After a period of rest, her blood pressure settled to around 140/70 mm Hg and her heart rate dropped to 80 beats per minute. Blood tests on admission revealed a raised troponin I level of 0.83 ng/ml (cut-off value for acute myocardial infarction, 0.5 ng/ml with 96% sensitivity and 94% specificity), and creatine phosphokinase (CPK) of 145 U/L (normal range, 40-160 U/L). Her renal and liver function tests were normal with a creatinine level of 53 umol/L. Electrocardiography demonstrated sinus rhythm and no Q wave or any ST or T changes. Because of the raised troponin I, she was started on low molecular weight heparin and aspirin 80 mg daily. Subsequent blood tests showed that the troponin I level peaked at 2.22 ng/ml 6 hours after the first test and CPK remained static at 120 U/L. The troponin I level subsequently dropped to 1.9 ng/ml at 12 hours and 0.6 ng/ml at 18 hours. She was seen by a cardiologist, and echocardiography showed normal contractility with ejection fraction of 60% and no valvular lesion. To exclude coronary heart disease, CT coronary angiogram was performed on day 2 and showed completely normal coronary arteries with an Agatstan INTRODUCTION Troponins are highly sensitive biomarkers of myocardial injury. They are useful in the diagnosis of acute myocardial infarction and risk stratification of acute coronary syndrome. Nonetheless, troponin level may be raised in many conditions other than acute myocardial infarction, posing a diagnostic difficulty for clinicians. We report an older woman who fell and sustained a scalp laceration. Troponin I was found to be high on admission; further investigation revealed no coronary artery disease.