A question for the medically inclined or if you have stayed at a Holiday Inn
 

When is a heart attack (MI) a heart attack (MI)? And not just a "event"?

Is it because I didn't have any of the usual symptoms other than back pain that it's just a "event"?


Saturday I wake up with increased back pain and a general feeling of being unwell. Pain is about a 6. I take a T-3 half a hour later it should be a 1 but it's a 4, still feel like crap.


So I drive myself to the ER where they take my blood and a EKG. My Troponin level is 45 and I have a drooping T- wave. These get me special treatment and I get a bed in the ER where they have me hooked up and take my blood 3 more times over 12 hrs Levels drop to 34, 31 then 28 with no change in the t- wave. The attending says "I don't know what to do with you." I pointed out I was obliviously getting better not worse and I had two 100 lbs dogs at home who needed me and he could use the bed. So send me home. Which he did (I promised if I felt worse to come back).

Today I get a phone call from the head of the implant program. I'm in a study to see if pacemakers actually help and no I don't have one (Group B). She refers to this incident as a "event"

When is a MI a MI and not just a "event"?

Hmm, maybe an "event" is when you live to ask what the difference is?

Seriously, don't fook around! Get in to see a cardiologist ASAP. Maybe get on some sort of blood thinner/aspirin regiment NOW?

It probably wouldn't hurt to do a nuke stress test and maybe even an angiogram if warranted (if the stress test/x-rays are inconclusive, etc.).


Take it easy man!

Thanks for your concern but already on thinners and 7 other meds 2x a day. I had the big one in March. Since then I have had 5 stints installed (they called it the "Full Metal Jacket") and numerous tests. Two other "events" about a month ago had me in ER beds for a couple days and more tests. The head of the implant program who called today is a cardiologist and it was her that called it a "event". My only symptom was/is back pain and that is why I'm wondering why it's a event and not a MI

Ah, my bust...I didn't connect the dots initially. I now remember someone (Joe Bob?) posting a thread a while back about it. I think I told you to lay off the poutine or some such. :D

Just a guess, but maybe the "event" refers to a spasm, or temporary oxygenated-blood supply/demand issue, and not (another) acute MI via blockage/rupture?

Also, with that many stents, would in-stent thrombosis (clotting) be a concern? I know you are on meds that likely minimize that possibility, but I'd at least want to rule it out.

Not much else I can offer. Not a doctor, and no Holiday Inn for miles... :p

Be well!

Are you sure your troponin was 45 and not 0.45??

A troponin of 45 is consistent with a significant heart attack. 0.45 is much less clear. My suspicion is that your value was 0.45, in my hospital you would have been in the cath lab quickly with a presenting troponin of 45. In some patients with known CAD small troponin leaks can be indicative of congestive heart failure. I would recommend you be seen by your cardiologist.

To answer your question, "event" is not really a medical term. It's a basket term sometimes used to refer to a small bump in enzymes without compelling symptoms to suggest an actual heart attack.

Yep, sounds like testing suggests what can be called a NonST elevation MI... ekg had twave inversions and positive enzymes (plus/minus)...

Depending on other factors, and your TIMI score, they often do a stress test, vs an angiogram... Troponin can also be elevated for other reasons (kidney disease comes to mind)

Lots of wiggle room, as it is an "art."

Not offering medical advice (no one would ever do that on the internet, and there is no doctor/patient relationship- this is just internet banter), but if it were me, I would see a cardiologist to review it all...

Good luck.

"An event," your doctor was not Nick Riviera MD, alumnus of the Upstairs Medical School was he?

Maybe there were no EKG changes. What kind of back pain? This can be indicative of a number of things. When you had MI, did they examine your abdominal vasculature?

From the Holiday Inn:
Just call back the doc that called you and say "hey the heck is an event?" They want you to join their study so they are more likely to take the time to answer your questions.
THEN, go to your cardiologist and make sure everything is OK.

Troponin was 45.

Back pain was a sharp stabbing pain under the left scapula (when the MI happened). Felt like someone was twisting a knife in me. Saturday was just a sharp constant pain. Same as today but today is a 1. T wave was/is drooping. Not sure about the abdominal vasculature but they were inside me twice over 3 days. First time was to insert 2 stents at 3am to keep me alive and the second was two days later a attending thought he heard a murmur (which could have been caused by a stent slipping). So the went back in thru my wrist and everything was where it was supposed to be. The Dr. doing the checking was very professional and checked everything out. I was awake for it.

I have a appointment with my cardiologist on the 12th

Thanks for the internet banter. I appreciate it.

Called my MD brother and read first line in above quote after roughly explaining event vs heart attack based on your input.

He said this is indication of a pre-heart attack.

Also said, heart attack will be indicated by EKG. Event not so much.

You did not have a heart attack based on a 2 minute cell phone call. You had an event which he described as an indication of a pre-heart attack only based on the Troponin level and dropping T wave.

Just talking based on an attempt to gather data.

I'm just your general idiot.
That being said, i would assume a heart attack has some sort of new damage to the heart muscle.
An event could be anything.
I'm glad you got off lucky SmileWavy

Interventional heart cath via the radial artery, cool.

Reason I ask is aneurysm can present as back pain, but it does not sound like that is your deal.

Could this have been a TIA?

Yep. Me brother did wander in his brief explanation of event.

In short, a heart attack is detectable and an event is all other.

Keep them blood thinners in the system.

As someone who has had a TIA, a quad by-pass, and congestive hear failure, I chuckled when I read this. :)
.
Take care, brother.

The story still isn't making sense. Most hospitals today use Troponin I. There is also a Troponin T test but I don't think this is used a much, at least not around where I work.

Anyhow, a normal Troponin level is usually less than 0.04 ng/ml. I suppose your hospital might be using a different unit scale but for you to have a troponin level of 45 and be told this was equivocal just seems odd. I would go over things with your cardiologist, I'm wondering if you aren't misplacing a decimal point somewhere...

Canada, eh? :D

Glad I could be of assistance. :p

...And you to bud!

That heart disease stuff is a real MF'er...

Up here we do use a different scale for measuring sugar in diabetes. Maybe they use a different scale for Troponin levels? I don't know but I will ask. I can find no reference to a different scale online though. We use the same scale as in the UK for diabetes. Example 5.6 is considered "normal" and that converts to "100" in the US scale. The night of my MI my BS was 25. That converts to 450 on the US scale. The ER Dr. said that was normal to happen. Your body senses it is in trouble and dumps as much sugar (energy) into the system as it can to help out. It was reduced back to normal levels over two days via insulin injections.

It was interesting. I was awake through the procedure. When the Dr. put the second stint in and then withdrew the wire (don't know what else to call it) I could feel the blood start to move thru my body again. It was like a warming feeling. Started in my chest and spread down and out. That and the fentanyl (turns out I reacted to the morphine) I was given, I felt great. :)

The back pain was the only symptom I had. No radiating pain, no jaw pain, no nausea, nothing. If I hadn't remembered a ambulance crew telling me about a woman who had a MI several years before and all she had was back pain I wouldn't have driven myself to the ER to get it checked out. The ER Dr. said if I had been able to find a comfortable place to sleep that night I probably wouldn't have woken up.

When they (same Dr.) put the 3 stints in my right he went thru both femoral artery's and my right radial artery. I was out completely for that one. Both femoral's leaked afterwards and didn't heal properly which caused other problems.

If you had severe chest pain, and a troponin of 45, and got 2 new stents (that's new info you added)... then you had a heart attack... No two ways about it.

Sounds like something was lost in communications when they were explaining it to you. Severe back pain with new murmur can also concern folks about aortic dissections...but that wouldn't explain the positive troponin...

A troponin of 8-10 is considered quite high. 45 is off the charts, and doesn't sound right... (as someone else pointed out also)...

Troponin is an enzyme in your heart, that gets released when the heart cells are getting damaged/ripped apart... (in layman's terms)

Glad you are ok.

That warming feeling was the dye used, causes a flushing type sensation.

Maybe they use a significantly different unit scale in Canada, dunno.

Met with the cardiologist today. He increasing my Metoprolol to 50 mg 2X a day to reduce my heart rate.

I asked about the troponin levels. In Manitoba they use two scales. For example he said the night of my MI (in March) the levels were 4000+. So 45 is cause for further investigation it is not as dangerous as first thought.