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Chest pain with elevated troponin assay in adolescents

Published online by Cambridge University Press:  20 September 2012

Matthew C. Schwartz ,
Shari Wellen ,
Jonathan J. Rome ,
Chitra Ravishankar  and
Shobha Natarajan
Matthew C. Schwartz*
Affiliation:
Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Shari Wellen
Affiliation:
Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Jonathan J. Rome
Affiliation:
Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Chitra Ravishankar
Affiliation:
Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Shobha Natarajan
Affiliation:
Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
*
Correspondence to: Dr M. C. Schwartz, MD, Division of Cardiology, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard Philadelphia, PA 19104, United States of America. Tel: +267 426 4952; Fax: +215 590 4620; E-mail: matthew.schwartz@orlandohealth.com
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Abstract

Objective

We sought to describe the evaluation, treatment, and follow-up of adolescents who presented to a single institution with chest pain and an elevated troponin I value in the absence of typical symptoms of pericarditis or myocarditis.

Materials and methods

We performed a retrospective review of patients in the age group of 10–18 years of age with no history of significant heart disease admitted to our institution from 2000 to 2010 after presenting with chest pain and an elevated troponin I value.

Results

A total of 16 patients were identified with a median age of 16.5 years (range 11.2–17.8 years). Of these 13 (81%) were male and 10 (63%) showed evidence of localised ST elevations on electrocardiogram. The median peak troponin I level was 17.8 nanograms per millilitre (range 0.89–227, normal less than 0.4). There were eight patients (50%) with a diagnosis of coronary vasospasm, three patients (20%) with atypical myopericarditis, one patient with coronary anomaly, one patient with hypercoagulable disorder, and one patient with prolonged supraventricular tachycardia. In two patients, no definitive diagnosis was made. There was one patient who needed catheter-based intervention, which involved stenting of a coronary artery after a procedure-related complication.

Conclusions

In our cohort of adolescents without history of significant cardiac disease, chest pain and elevated troponin I levels were attributed to a variety of causes. Although coronary vasospasm and atypical myopericarditis were seen most commonly, coronary anomaly was identified in one case. Magnetic resonance imaging proved a useful diagnostic tool to assess coronary artery anatomy and myocardial changes suggestive of myocarditis. On the basis of these results and a review of the literature, a general evaluation algorithm is presented.

Keywords

Myocardial infarctionvasospasmtroponin
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 3 , June 2013 , pp. 353 - 360
Copyright
Copyright © Cambridge University Press 2012 

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References

1. Kane, DA, Fulton, DR, Saleeb, S, Zhou, J, Lock, JE, Geggel, RL. Needles in hay: chest pain as the presenting symptom in children with serious underlying cardiac pathology. Congenit Heart Dis 2010; 5: 366–373.CrossRefGoogle ScholarPubMed
2. Desai, A, Patel, S, Book, W. “Myocardial infarction” in adolescents: do we have the correct diagnosis? Pediatr Cardiol 2005; 26: 627–631.Google Scholar
3. Lane, JR, Ben-Shachar, G. Myocardial infarction in healthy adolescents. Pediatrics 2007; 120: e938–e943.CrossRefGoogle ScholarPubMed
4. Brown, JL, Hirsh, DA, Mahle, WT. Use of troponin as a screen for chest pain in the pediatric emergency department. Pediatr Cardiol 2012; 33: 337–342.CrossRefGoogle ScholarPubMed
5. Cooper, LT Jr. Myocarditis. N Engl J Med 2009; 360: 1526–1538.Google Scholar
6. Lange, RA, Hillis, LD. Clinical practice. Acute pericarditis. N Engl J Med 2004; 351: 2195–2202.Google Scholar
7. Cannon CP, Braunwald E. Unstable angina and non ST elevation myocardial infarction. In: Bonow RO, Mann DL, Zipes DP, Libby P (eds.). Bonow: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th edn. Elsevier Saunders, Philadelphia, 2011, 1178–1209.Google Scholar
8. Thygesen, K, Alpert, JS, White, HD, et al. Universal definition of myocardial infarction. Circulation 2007; 116: 2634–2653.Google Scholar
9. Holt, DB, Singh, GK, Rhee, EK, Billadello, J, Ludomirsky, A. Images in cardiovascular medicine. Prinzmetal angina in an adolescent: adjunctive role of tissue synchronization imaging. Circulation 2005; 112: e91–e92.CrossRefGoogle Scholar
10. Kato, H, Ichinose, E, Kawasaki, T. Myocardial infarction in Kawasaki disease: clinical analyses in 195 cases. J Pediatr 1986; 108: 923–927.Google Scholar
11. Mouhaffel, AH, Madu, EC, Satmary, WA, Fraker, TD Jr. Cardiovascular complications of cocaine. Chest 1995; 107: 1426–1434.Google Scholar
12. Sprecher, DL, Schaefer, EJ, Kent, KM, et al. Cardiovascular features of homozygous familial hypercholesterolemia: analysis of 16 patients. Am J Cardiol 1984; 54: 20–30.Google Scholar
13. Towbin, JA, Bricker, JT, Garson, A Jr. Electrocardiographic criteria for diagnosis of acute myocardial infarction in childhood. Am J Cardiol 1992; 69: 1545–1548.CrossRefGoogle ScholarPubMed
14. George, AK, Kunwar, AR, Awasthi, A. Acute myocardial infarction in a young male on methylphenidate, bupropion, and erythromycin. J Child Adolesc Psychopharmacol 2005; 15: 693–695.Google Scholar
15. Thompson, J, Thompson, JR. Acute myocardial infarction related to methylphenidate for adult attention deficit disorder. J Emerg Med 2010; 38: 18–21.CrossRefGoogle ScholarPubMed
16. Bruce, MA, Spodick, DH. Atypical electrocardiogram in acute pericarditis: characteristics and prevalence. J Electrocardiol 1980; 13: 61–66.Google Scholar
17. Gerbaud, E, Harcaut, E, Coste, P, et al. Cardiac magnetic resonance imaging for the diagnosis of patients presenting with chest pain, raised troponin, and unobstructed coronary arteries. Int J Cardiovasc Imaging 2012; 28: 783–794.CrossRefGoogle ScholarPubMed
18. Friedrich, MG, Sechtem, U, Schulz-Menger, J, et al. Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol 2009; 53: 1475–1487.Google Scholar
19. Kehl, DW, Iqbal, N, Fard, A, Kipper, BA, De La Parra Landa, A, Maisel, AS. Biomarkers in acute myocardial injury. Transl Res 2012; 159: 252–264.CrossRefGoogle ScholarPubMed