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Elevated troponin levels in previously healthy children: value of diagnostic modalities and the importance of a drug screen

Published online by Cambridge University Press:  05 March 2013

Poonam P. Thankavel ,
Arshid Mir  and
Claudio Ramaciotti
Poonam P. Thankavel*
Affiliation:
Department of Pediatrics, Division of Cardiology, UT Southwestern Medical Center at Dallas, Dallas, Texas, United States of America Children's Medical Center of Dallas, Dallas, Texas, United States of America
Arshid Mir
Affiliation:
Department of Pediatrics, Division of Cardiology, UT Southwestern Medical Center at Dallas, Dallas, Texas, United States of America Children's Medical Center of Dallas, Dallas, Texas, United States of America
Claudio Ramaciotti
Affiliation:
Department of Pediatrics, Division of Cardiology, UT Southwestern Medical Center at Dallas, Dallas, Texas, United States of America Children's Medical Center of Dallas, Dallas, Texas, United States of America
*
Correspondence to: Dr P. P. Thankavel, MD, Department of Pediatrics, Division of Pediatric Cardiology, UT Southwestern Medical Center, Children's Medical Center of Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America. Tel: +1 214 456-2333; Fax: +1 214 456-8066; E-mail: [email protected]
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Abstract

Background: Myocardial injury in previously healthy children is rare, with a wide range of aetiologies. It is increasingly being identified on the basis of elevated troponin levels during routine evaluation of cardiorespiratory symptoms. Establishing the aetiology remains challenging because of the lack of an accepted work-up algorithm. Our objective was to delineate the contribution of diagnostic modalities and troponin patterns towards the final diagnosis. Methods: A retrospective chart review of previously healthy patients admitted to the Pediatric Cardiology Service with myocardial injury was carried out. Data analysed included echocardiograms, electrocardiograms, cardiac catheterisations, magnetic resonance imaging, drug screen tests, troponin values, and final diagnosis. Results: A total of 32 patients were identified. The diagnoses were: myocarditis in 16 patients, vasospasm due to drug use in seven, myopericarditis in six, anomalous coronary artery origins in two, and Prinzmetal's angina in one patient. The electrocardiograms were abnormal in 27 of the 32 patients (84%), echocardiograms in 18 of the 32 patients (56%), cardiac magnetic resonance imaging in two of the four patients (50%), urine drug screen in five of the 25 patients (20%), and cardiac catheterisations in two of the 15 patients (13%). Conclusions: Myocarditis is the most common aetiology of myocardial injury in children. Clinical history remains the basic screening tool; drug screens help identify coronary vasospasms secondary to drug use (22% of our cohort). Patients with anomalous coronaries had exertional symptoms. Initial troponin levels and progression were not diagnostic or prognostic. Catheterisation is of limited value and did not change management. Magnetic resonance imaging with gadolinium enhancement is probably the most useful test when initial evaluation is not diagnostic.

Keywords

Chest paintroponin elevation
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 2 , April 2014 , pp. 283 - 289
Copyright
Copyright © Cambridge University Press 2013 

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