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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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