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What Causes Chest Pain And Elevated Troponin Level With Normal ECG?
Question: I had elevated troponin it was 44 the dr said it's not high enough for heart attack that should be in the thousands or millions but it was still elevated then six hours later went down to normal under ten and the troponin tests I've had done since then are all under
I was in a packed out cinema and in full blown anxiety attack when I felt the pain shot from my chest down my arm like a lightning bolt then I got the 44 reading, so I'm curious to know if anyone knows if panic attacks and anxiety can elevate troponin levels only for them to return to normal once panic seizes
I also suffer chronic constant severe pain from fibromyalgia which is worse in my left side more so shoulder and arm and left side of chest
I've had an echocardiogram and a ct scan of the heart which were both normal
I just need to know if I'm in danger of a heart attack
I was in a packed out cinema and in full blown anxiety attack when I felt the pain shot from my chest down my arm like a lightning bolt then I got the 44 reading, so I'm curious to know if anyone knows if panic attacks and anxiety can elevate troponin levels only for them to return to normal once panic seizes
I also suffer chronic constant severe pain from fibromyalgia which is worse in my left side more so shoulder and arm and left side of chest
I've had an echocardiogram and a ct scan of the heart which were both normal
I just need to know if I'm in danger of a heart attack
Brief Answer:
It is possible in panic attacks
Detailed Answer:
Hi,
I went through your query and can understand your concerns regarding elevated troponin levels.
From what you have mentioned, you definitely seem to have a panic attack. During panic attack, the heart starts beating faster. This increased workload on the heart can lea to slight increase in cardiac enzymes level (in your case troponin). After you relax and the attack gets over, the normal cardiac activity resumes and the troponin level comes down gradually. In case of heart attack, the levels of troponin elevation will be very high and the time to come down to normal will be much slower (upto a week).
As you have mentioned, your echocardiogram and CT scan of heart has been found to be normal. I don't think there is anything to worry about and you should relax about it.
I am not sure how often do you have panic attacks, but if it is frequent enough, you should consider revising your treatment for the same. You have already tried many medications and I do hope you are doing better on the current set of medications. In addition you can also opt for cognitive behavior therapy for panic attacks. It will help you relax and defocus from the anxiety.
I do hope that I was able to answer your query. Please feel free to ask any further doubt that you may have.
Best wishes,
Dr. Sunil Gupta
It is possible in panic attacks
Detailed Answer:
Hi,
I went through your query and can understand your concerns regarding elevated troponin levels.
From what you have mentioned, you definitely seem to have a panic attack. During panic attack, the heart starts beating faster. This increased workload on the heart can lea to slight increase in cardiac enzymes level (in your case troponin). After you relax and the attack gets over, the normal cardiac activity resumes and the troponin level comes down gradually. In case of heart attack, the levels of troponin elevation will be very high and the time to come down to normal will be much slower (upto a week).
As you have mentioned, your echocardiogram and CT scan of heart has been found to be normal. I don't think there is anything to worry about and you should relax about it.
I am not sure how often do you have panic attacks, but if it is frequent enough, you should consider revising your treatment for the same. You have already tried many medications and I do hope you are doing better on the current set of medications. In addition you can also opt for cognitive behavior therapy for panic attacks. It will help you relax and defocus from the anxiety.
I do hope that I was able to answer your query. Please feel free to ask any further doubt that you may have.
Best wishes,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much
I suffer daily with chest pain left arm ache jaw pain and shoulder pain and sweating my gp has put it down to my anxiety and fibromyalgia can these disorders create these cardiac like symptoms ?
I also fear heart attacks and cannot sleep due to the pains and fear
I suffer from severe anxiety and panic disorder can either of these cause troponins to elevate to 44 then return to normal less then 10 after six hours ?
My medication is not helping can you recommend a medicine that I can suggest to my gp that will help my severe anxiety and chronic pain ?
I suffer daily with chest pain left arm ache jaw pain and shoulder pain and sweating my gp has put it down to my anxiety and fibromyalgia can these disorders create these cardiac like symptoms ?
I also fear heart attacks and cannot sleep due to the pains and fear
I suffer from severe anxiety and panic disorder can either of these cause troponins to elevate to 44 then return to normal less then 10 after six hours ?
My medication is not helping can you recommend a medicine that I can suggest to my gp that will help my severe anxiety and chronic pain ?
Brief Answer:
Paroxetine might help.
Detailed Answer:
Hi,
Thanks for following up. I can understand why you are so distressed. From what you have mentioned, you certainly seem to be suffering from an anxiety disorder and your panic attacks are definitely due to that. It is the panic attack which is leading you to worry about panic attacks. This symptom is an integral part of your disorder.
As I mentioned in my last reply, your elevated troponin levels must have occurred due to increased heart rate due to the panic attack. Since it was not a heart attack, the levels returned back to normal within 6 hours. In case of heart attack, the levels come back to normal very slowly.
Since your medication is not helping your current symptoms, I thing a change is warranted. Going through your current set if medications and those that you have tried earlier, I would recommend paroxetine as a choice. It is an effective drug in your condition. You can discuss regarding this with your doctor. In addition, start exercising daily. It will help you relax and help with your symptoms.
I do hope that I was able to answer your query. Please let me know if you have any further questions. I will try my best to help you out. In case you decide to close the discussion, please do rate the answer.
Best wishes,
Dr. Sunil Gupta
Paroxetine might help.
Detailed Answer:
Hi,
Thanks for following up. I can understand why you are so distressed. From what you have mentioned, you certainly seem to be suffering from an anxiety disorder and your panic attacks are definitely due to that. It is the panic attack which is leading you to worry about panic attacks. This symptom is an integral part of your disorder.
As I mentioned in my last reply, your elevated troponin levels must have occurred due to increased heart rate due to the panic attack. Since it was not a heart attack, the levels returned back to normal within 6 hours. In case of heart attack, the levels come back to normal very slowly.
Since your medication is not helping your current symptoms, I thing a change is warranted. Going through your current set if medications and those that you have tried earlier, I would recommend paroxetine as a choice. It is an effective drug in your condition. You can discuss regarding this with your doctor. In addition, start exercising daily. It will help you relax and help with your symptoms.
I do hope that I was able to answer your query. Please let me know if you have any further questions. I will try my best to help you out. In case you decide to close the discussion, please do rate the answer.
Best wishes,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
So my daily severe symptoms including severe central chest pain that radiates to my left arm back of my shoulder and up info my neck and jaw, the profuse sweating, the palpatations and the breathlessness are all anxiety even when I'm not having a panic attack? I am constantly thinking about my heart and having a heart attack 24/7 I'm that scared
Can anxiety create these intense exact cardiac symptoms? X
Would the ct scan of my heart rule out everything? Including small arteries? I know it came back saying everything was normal but I don't know what was normal like valves and arteries
I constantly feel like this and I'm so exhausted and I feel genuinely unwell which frightens me more I'm convinced it's my heart
Can anxiety create these intense exact cardiac symptoms? X
Would the ct scan of my heart rule out everything? Including small arteries? I know it came back saying everything was normal but I don't know what was normal like valves and arteries
I constantly feel like this and I'm so exhausted and I feel genuinely unwell which frightens me more I'm convinced it's my heart
Brief Answer:
Anxiety can lead to all the symptoms that you have
Detailed Answer:
Hi,
Thanks for following up. Anxiety is condition which can involve any XXXXXXX of the body including cardiac. Your symptoms are very much possible due to anxiety. The most important thing about anxiety is more you worry about the symptoms, more is the frequency and intensity of symptoms. Slight discomfort can cause anxiety which can lead to cardiac symptoms, which further increase anxiety leading to further increase of cardiac symptoms and the vicious cycle continues.
A combination of echocardiogram and CT scan rules out most of the cardiac conditions. Even small arteries blockage will lead to some amount of cardiac damage, which can be picked up by these tests. They are usually the non invasive tests carried out initially. They pick up conditions of heart musculature, arteries and valves as well. Only when these tests show something, further invasive tests are planned. So, I think you should rest assured about your heart.
I can understand how you must be feeling with the constant symptoms that you are having. But these constant worries are only making matters worse. What you should be concerned about is how to treat your worries and anxiety. That will solve most of the problems that you are having.
I really wish that you are able to overcome your anxiety soon and lead a completely healthy life. Please let me know if I can be of any further help. I will try my bets possible to help you out.
Best wishes for a very speedy recovery and a completely healthy life ahead,
Dr. Sunil Gupta
Anxiety can lead to all the symptoms that you have
Detailed Answer:
Hi,
Thanks for following up. Anxiety is condition which can involve any XXXXXXX of the body including cardiac. Your symptoms are very much possible due to anxiety. The most important thing about anxiety is more you worry about the symptoms, more is the frequency and intensity of symptoms. Slight discomfort can cause anxiety which can lead to cardiac symptoms, which further increase anxiety leading to further increase of cardiac symptoms and the vicious cycle continues.
A combination of echocardiogram and CT scan rules out most of the cardiac conditions. Even small arteries blockage will lead to some amount of cardiac damage, which can be picked up by these tests. They are usually the non invasive tests carried out initially. They pick up conditions of heart musculature, arteries and valves as well. Only when these tests show something, further invasive tests are planned. So, I think you should rest assured about your heart.
I can understand how you must be feeling with the constant symptoms that you are having. But these constant worries are only making matters worse. What you should be concerned about is how to treat your worries and anxiety. That will solve most of the problems that you are having.
I really wish that you are able to overcome your anxiety soon and lead a completely healthy life. Please let me know if I can be of any further help. I will try my bets possible to help you out.
Best wishes for a very speedy recovery and a completely healthy life ahead,
Dr. Sunil Gupta
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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