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Elevation of Troponins in RhabdomyolysisElevation of Troponins in Rhabdomyolysis FREE TO VIEW

Carla Nobre, MD; Boban Thomas, MD, FCCP
Author and Funding Information

From the Centro Hospitalar Barreiro Montijo – Internal Medicine (Dr Nobre); and Centro Hospitalar Barreiro Montijo – Cardiology (Dr Thomas).

Correspondence to: Boban Thomas, MD, FCCP, Centro Hospitalar Barreiro Montijo – Cardiology, Barreiro, Barreiro 1900-280, Portugal; e-mail: bobantho@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(2):415. doi:10.1378/chest.13-2118
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To the Editor:

In their excellent comprehensive clinical review on rhabdomyolysis in CHEST (September 2013), Zimmerman and Shen,1 to our surprise, did not mention that levels of troponin I and troponin T may be elevated. As clinicians, we realized that this can cause some difficulty in the interpretation of these specific biomarkers of cardiac injury, especially since rhabdomyolysis may occur with medications prescribed for patients with a history of heart disease, namely, statins, fibrates, and amiodarone. Up to 17% of patients may have elevated troponin levels, according to a study performed in the ED.2

The causes of the elevation are debated, but it is important to emphasize that with hydration, the cornerstone of the treatment of rhabdomyolysis, troponin levels revert to normal.3 It is important at this stage not to subject the patient to either conventional or multidetector CT coronary angiography, to prevent contrast nephropathy. In our clinical experience, these patients can be reassessed for coronary artery disease after the episode of rhabdomyolysis with noninvasive imaging for significant ischemia and subsequent management determined accordingly. The etiology of the rhabdomyolysis can alert the physician to what may not be a case of a false-positive elevation, as is the case with cocaine, which can cause both rhabdomyolysis and acute coronary syndrome.

References

Zimmerman JL, Shen MC. Rhabdomyolysis. Chest. 2013;144(3):1058-1065. [CrossRef] [PubMed]
 
Li SF, Zapata J, Tillem E. The prevalence of false-positive cardiac troponin I in ED patients with rhabdomyolysis. Am J Emerg Med. 2005;23(7):860-863. [CrossRef] [PubMed]
 
Jaffe AS, Vasile VC, Milone M, Saenger AK, Olson KN, Apple FS. Diseased skeletal muscle: a noncardiac source of increased circulating concentrations of cardiac troponin T. J Am Coll Cardiol. 2011;58(17):1819-1824. [CrossRef] [PubMed]
 

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References

Zimmerman JL, Shen MC. Rhabdomyolysis. Chest. 2013;144(3):1058-1065. [CrossRef] [PubMed]
 
Li SF, Zapata J, Tillem E. The prevalence of false-positive cardiac troponin I in ED patients with rhabdomyolysis. Am J Emerg Med. 2005;23(7):860-863. [CrossRef] [PubMed]
 
Jaffe AS, Vasile VC, Milone M, Saenger AK, Olson KN, Apple FS. Diseased skeletal muscle: a noncardiac source of increased circulating concentrations of cardiac troponin T. J Am Coll Cardiol. 2011;58(17):1819-1824. [CrossRef] [PubMed]
 
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