Thanks for visiting my RU-vid channel. I'm a professor of Emergency Medicine at the University of Manchester, and I work at Manchester University NHS Foundation Trust as an honorary consultant in Emergency Medicine and the Group Director of Research & Innovation. My channel is devoted to medical education and knowledge translation. I have special interests in diagnostics, new medical technologies, evidence-based medicine, acute coornary syndromes, cardiac biomarkers, cardiac troponin, ECG interpretation and COVID-19.
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My opinions do not necessarily reflect those of my employer.
Thank you so much sir ! I was really confused regarding the axis calculation finally understood it with the help of thumb's method ❤ lots of love from Pakistan
Small rise in Trop in 2hrs ER Couldn't determine a Heart attack. Suggested broken heart syndrome due to a death. Maybe that's why ER referred patient to cardiologist for further testing and why cardiologist tests was scheduled weeks out. Still waiting to go to stress/ nuclear tests. Thanks for info. Trying to stay positive
Good question! I think it depends on the timing and degree of reperfusion. Wellens type A has terminal T inversion, suggesting early reperfusion after an LAD occlusion that has partially resolved. Wellens type B is likely the evolution over time after reperfusion, as the T wave inversion becomes symmetrical and complete. Steve Smith has written a really nice blog on this - hqmeded-ecg.blogspot.com/2013/11/why-we-need-12-lead-st-segment.html?m=1
The rise or fall is only considered abnormal if one level goes above the 99th percentile upper reference limit. At the moment, changes within the normal range aren’t considered pathological. Perhaps that might change in the future when we understand more about cardiac troponin kinetics, but that’s the current approach.
4 to 5 in a week or two... stays at 4a week or two ago, then tests at 5 with cardiac symptoms and atrial flutter on EKG. The new testing seems to be causing more confusion than not, unless it is clear from other signs and symptoms that either it's an MI or not. Ultra sensitive troponin levels in a couple of hours in an ED may not show any changes, yet there can still be major symptoms, abnormal troponin levels in blood samples, especially chronic tachycardia and/or bradycardia. It seems there is far, far too much emphasis on troponin levels and not enough time in an ED to see changes that are important. To send a patient on their way without followup is likely to result in a catostraphic event, yet reliance on troponin level changes in an ED is not advisable. Find out what is causing the problem. Having a test with so many false positives or negatives, as you said, you may as well flip a coin to guess.. 50-50% chance of an MI or not, yet the patients come in with symptoms. It may not be a cardiac problem, but you should be aware of what brought a person to the ED, and be able to make a diagnosis, and not leave a patient with very comcerning symptoms and no answers. Keep in mind that different tests have different reference ranges as well. Here, we have <4 as the standard. 5+ is outside the normal of 99% of the population tested. It would be helpful to have a video about differential diagnosis of patients with heart flutter and small elevations of troponins. The 20% change could be from 4 to 5 (0.004ng/L to 0.005ng/L) or a 25%^. Possibly a small MI, maybe a difference in the test, perhaps a laundry list of other things. Most EDs here in the states aren't going to keep a patient past 2 hours, thus not long enough to make a determination. Perhaps patient education in elementary, junior high, high school, and adult populations. I'm not sure the global medical community has any handle on these newer ultra sensitive troponin tests. It may be prudent to discharge many of these patients, yet it is necessary to discover what the problem is that brought the patient to the ED. A differential diagnosis is necessary, as discharging a patient simply because they didn’t have an MI is ignoring other, just as serious issues. Differential diagnosis is a necessity, least we aren't treating patients as people, and simply as a certain condition. Is the patient breathing OK? Just asking. I literally experienced a doctor who totally missed a patient's main concern, and discharged a patient based strictly on an unchanging troponin level, yet totally missed the patient's breathing problem. It was pretty horrific.
Thanks for your comment! You’re right about other causes but the key is to remember that troponin is just a marker of myocardial injury. There are many other problems that don’t cause injury to the myocardium, so we can’t expect troponin to detect them. It’s not a failure of the test - more a matter of understanding the test and it’s role. Troponin is extremely helpful to detect myocardial injury and myocardial infarction - we just couldn’t detect many of the conditions we can now with high-sensitivity troponin assays. However, you’re absolutely right that it is just a blood test for one thing - and therefore only one part of a more holistic evaluation, which is crucial for every patient encounter.
Probably. It depends on the particular test (assay) and the units that this was measured in. 4.5ng/L would be within normal for every commercially available assay at the moment. However, 4.5 micrograms per litre would be very high.
My troponin was 14. 1 hour later is was 10. EKG normal, x ray normal. Elevated blood pressure and shortness of breath was contributed to a panic attack… sound right?
I can’t give individual medical advice on here, but those troponin results may well have been within normal. (I can’t say for sure without knowing the particular test and the units). The troponin, ECG and x-ray can’t make the diagnosis of a panic attack - they are done to rule out other serious conditions. Once a clinician has done that, they then have to work out what’s likely to have caused the symptoms based on their overall evaluation. It’s good practice to talk this through with you. I hope you’re feeling better.
This happen to me April 2023. Male 42 years old. Fit, non smoker, no drug use, no drinking Chest pain after a 15 km run. Few days in the hospital after the false positive was found
It actually depends on where you are. Assuming it’s the Roche troponin T test, the normal range overall is up to 14ng/L, or 17ng/L in men and 9ng/L in women. In the US, the overall normal range is 19ng/L.
Hi Richard. Thanks for the ECG example. I was just wondering how you interpret the ECG as a Mobitz type 2. I personally would only say that it is a second degree block 2:1, as I cannot compare one PR segment to the next, as there is a drop after one complex.
Yes, you're right that it's second degree heart block with a 2:1 ratio, but that's also Mobitz type 2. Mobitz type 1 is Wenckebach, with a progressively lengthening PR interval until a beat drops, whereas Mobitz type 2 doesn't have that feature - they drop despite a fixed PR interval. It can occur in any ratio (or even with no discernable pattern), but in this case it's 2:1.
Dr. Body, thank you so much for sharing you insights on this topic! It really helps me as someone who is new to this field to appreciate the important of EM research! The examples you gave made me feel more interested into this field. However, I have a question on the saving life part: do you mean that by asking more questions and conduct more experiments with patients, there is a increased chance of discovering a better treatment and therefore saving more lives? Thank you so much for the information! 11:31
Thank you very much for your kind comments! The point you made is absolutely true. I was trying to show, in that segment, that even offering patients the opportunity to participate in research saves lives. The treatments we study aren’t usually offered in routine care until we finish the research. This means that patients are getting an opportunity to receive treatments that they otherwise wouldn’t. Sometimes those treatments will be found to be ineffective. However, sometimes we find that they save lives. In that case, the patients who participated and received the new treatment have had the benefit of a treatment that improved their outcome. We only know that with hindsight. However, when we look at data from previous trials we can work out how many people survived to the end of the trial because they participated in the trial. When we ask patients if they’d like to participate in research, we have to be careful not to over-promise on such benefits because we simply don’t know (at that time) whether there will be a benefit. But when we look back we can often see that participating in the trial had health benefits in itself.
I am working working with ultrasonogram validity in osteoarthritis knee, in that case I get only 3 papers! I choose osteoarthritis or knee osteoarthritis for searching?
This is the best I'm an EM/IM physician oftenly encounter this issue. I wonder if patients with Chronic kidney disease have this cuz usually those patients have baseline elevated troponin.
Here's a link to the paper on this, led by the fantastic Ola Hammarsten, who taught me a huge amount on this important issue: www.degruyter.com/document/doi/10.1515/cclm-2023-0028/html
Hi Richard, big fan of your content. I'm a healthy, 33 year old athlete and Soldier in Alaska. I recently went to the ER because I was feeling a little panicky with some chest discomfort. They said I had elevated troponin levels. During my visit they tested me twice and the results were the same. The levels neither decreased or increased. They checked for blood clots and that was negative. They also did an ultrasound of my heart and said there was no damage. I'm very unfamiliar with the troponin tests. I watched your video on high sensitivity troponin tests tonight and found the information very educational. I've been having some anxiety post ER visit. I'm a bit of a gym rat and don't want that lifestyle to change. I've been pushing my body very hard lately in the gym ding both high intensity cardio and weightlifting. I'm not asking for a diagnosis, but could the troponin levels just be from fatigue and pushing myself in the gym without adequate rest? Thank you! -Seth .
Hi Seth, sorry to read about your recent visit to the ER and the blood results. There are lots of reasons why troponin might be raised in someone who’s apparently healthy. It could be what we call chronic myocardial injury. Chronic just means it’s been going on for a long time, ie not a sudden thing. It can be heart problems (like valve disease, the heart’s pump not working as it should, or certain other problems) and there are some things that aren’t heart problems (like kidney disease). Sometimes very high blood pressure, diabetes or similar issues can cause a higher troponin. Sometimes it’s not from heart muscle at all. Occasionally we see high results from skeletal muscle (ie the muscles of your body rather than the heart). This is rare but it does happen. Sometimes people have certain antibodies that confuse the test - and so you get a high result even though you don’t actually have a high level of troponin. I can’t give health advice on RU-vid. Therefore I can just say that it would be reasonable to ask your doctor if this could be looked into some more, maybe by running a test from a different manufacturer to see if the results are still high as a starting point - though it depends on the context and how high the result was.
@@RichardBody Thank you so much for your thorough reply Richard. I'll be having a visit with a cardiologist in the near future to talk about all these things. I appreciate all that information. I just have to be patient in dealing with all of this 🙂
Thank you for this video, I’d love to know why Cardiologist say “don’t worry” when I’ve consistently had mildly raised Troponins for the past year or so - but ….ECG , Cardisc MRI , CT angiogram show heart is fine no damage?
Do you know the the number? I had elevated troponin of 0.26 ng/mL (Normal is 0.04 <). After twelve hours they retested, it was 0.02. My cardiologist said it was due to demand which in my case stress. They had to put me on oxygen bc my oxygen level was 88%.
@@irineojason thing is it changes in different country and even within country different hospitals so in lines the heart attack number was >30 and I had 33
I spend 3 weeks looking up various resources on how to search Medline and Embase but yours was the clearest I've ever come across. I feel like I've seen a light. Thanks for doing this video
