Cardiologist, Medical Director of Chest Pain Unit, University Hospital of Heidelberg, Germany
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Clinical Cases: Diagnostic relevance of elevated hs-cTnT
19 November 2021
Case
69-year old man
Key signs and symptoms
Acute left-sided chest tightness/discomfort at rest for the past 8 hours, duration 30 – 40 minutes, brief symptom-free phases Exertional dyspnoea for several months
Medical history/
Clinical examination
Peripheral arterial occlusive disease (PAOD) IIa bilateral,
walking distance 270 m, active smoker, arterial hypertension,
hypercholesterolaemia
Laboratory test
results
Result
Reference range
CRP 9 mg/dL
< 5 mg/dL
GFR 55 mL/min/1.73 m2
>90 mL/min/1.73 m2
Leukocytes 9.2/nL
4.4 – 11.3/nL
D-dimer 1.3 mg/dL
< 0.5 mg/dL
NT-proBNP 250 ng/L
900 ng/L heart failure (HF) likely if 50–75 year-old (confirmation with imaging)
ECG
Characteristic ECG
with ST segment
depression in the
lateral leads.
According to the universal definition, the diagnosis of AMI is confirmed:
•
The cTnT-hs concentration within 24 hours of the index event was above the 99th percentile cut-off value (14 ng/L) on at least one occasion
•
A typical rise and fall in the cTnT-hs levels was also observed
•
The clinical criterion for myocardial ischemia is fulfilled by the typical angina pectoris symptoms and ECG changes
•
Coronary angiography shows high grade stenosis of the ramus interventricularis anterior / Ieft anterior descending artery (RIVA / LAD)
Conclusion
All three criteria for an acute myocardial infarction are satisfied: elevated cTnT-hs level, typical kinetic of cTnT-hs release and clinical presentation with ECG changes.
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