title: Persistent troponin elevation in a patient with cardiac amyloidosis.
abstract: A 79-year-old patient repeatedly presented with chest discomfort and dyspnea on exertion. With echocardiography a prominent left ventricular and septal hypertrophy was detected with reduced left ventricular function. Despite successful revascularization and excellent results after stenting, the patient showed persistently elevated troponin levels. To investigate the abnormal findings of persistent troponin elevation, septal hypertrophy, and heart failure we performed endomyocardial biopsies which showed widespread myocardial amyloidosis. Amyloid subtyping revealed transthyretin amyloidosis. This is the first case showing persistent troponin elevation in a patient with tranthyretin amyloidosis. Very few other cases have been published on the topic of cardiac amyloidosis and troponin elevation so far. Our case serves as an illustrating example in the differential diagnosis of nonischemic causes of persistent troponin elevation. It is important to consider cardiac amyloidosis in patients with troponin elevation and heart failure since the clinical management differs significantly from other causes of heart failure.
authors.affiliation: Medizische Klinik III, University Hospital of Tübingen, Otfried-Müller-Str, Tübingen 72076, Germany.
authors.forename: Bjoern F
authors.initials: BF
authors.lastname: Kraemer
authors.forename: Peter
authors.initials: P
authors.lastname: Seizer
authors.forename: Tobias
authors.initials: T
authors.lastname: Geisler
authors.forename: Karin
authors.initials: K
authors.lastname: Klingel
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kandolf
authors.forename: Stephan
authors.initials: S
authors.lastname: Lindemann
authors.forename: Meinrad
authors.initials: M
authors.lastname: Gawaz
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004452:Echocardiography; D006331:Heart Diseases / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D011228:Prealbumin / Q000378:metabolism; D015607:Stents; D013575:Syncope / Q000097:blood / Q000209:etiology; D014336:Troponin / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D011228:Prealbumin; D014336:Troponin