You may know that congestive heart failure can cause troponin elevation, but would this elevation necessarily stay there or can it “spike”?

A blood test that comes back elevated for troponin always means that something is going on — this is not a lab error, since the cardiac troponin test is extremely sensitive.

If the elevation of troponin is in the “indeterminate range” or “grey area,” and subsequent blood tests show a fall, this is not indicative of a heart attack. But something happened.

If prior, the patient was diagnosed with congestive heart failure (chronic, not acute), one might think that this higher-than-normal reading of troponin (a protein enzyme that’s leaked from damaged cardiac tissue) was triggered by congestive heart failure.

On the other hand, if subsequent tests show a drop back to a normal level—this points more towards an acute (sudden) event. So here’s the big question:

When congestive heart failure causes elevated troponin, can this elevation be temporary, transient, intermittent?

Or would it necessarily be a new “baseline normal” for the patient, since CHF doesn’t come and go, but is there to stay?

“It is persistently flat; it is usually only mildly elevated and does not rise and fall like in an acute myocardial infarction,” says Dr. Adam Splaver, clinical cardiologist and co-founder of NanoHealth Associates, a practice that explores the molecular level of cardiovascular disease.

“Flat” refers to the same ongoing level, not fluctuating back and forth between indeterminate range and normal..

If a CHF patient’s troponin is elevated in the indeterminate range fairly soon after suspicious symptoms begin, and then it actually drops on subsequent tests, this rise and fall is not from the congestive heart failure; it’s from something else.

But the grey area range is not sufficient to diagnose heart attack (myocardial infarction).

Dr. Splaver says, “Troponins are never suggestive of CHF; they are only an indicator that heart damage has occurred.”

So even though chronic CHF can indeed cause an elevation, it’s of the persistent or “flat” type, not the rise-and-fall type.

Doctors need to find out what caused the rise-and-fall in a patient with chronic CHF.

If a patient’s troponin result is, say, 0.18 (normal is zero to 0.04 for cardiac troponin T), this is not a normal result; it’s indeterminate and warrants another test several hours later.

If the second test is lower (say, 0.13), this is a “fall,” even though we’re talking a decimal fraction of hundredths. Remember, this test is highly sensitive.

Dr. Splaver says that this scenario suggests that an acute event occurred (but not a heart attack), even though 0.18 isn’t that much more than 0.04 from a mathematical perspective.

So what else might have been going on with such a patient? Again, doctors will look into this.

Other causes of a rise-and-fall of troponin into the indeterminate range and then to the normal range include a coronary artery spasm and atrial fibrillation.

However, in order for an episode of AF to elevate troponins, there would have to be severe underlying coronary artery disease.

Dr. Splaver is board certified in cardiology, internal medicine and echocardiography, and is a registered physician in vascular interpretation and trained in age management medicine.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  


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