Cardiology in the Young

Original Articles

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

Poonam P. Thankavela1a2 c1, Arshid Mira1a2 and Claudio Ramaciottia1a2

a1 Department of Pediatrics, Division of Cardiology, UT Southwestern Medical Center at Dallas, Dallas, Texas, United States of America

a2 Children's Medical Center of Dallas, Dallas, Texas, United States of America

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.

(Received August 28 2012)

(Accepted February 03 2013)

(Online publication March 05 2013)

Keywords

  • Chest pain;
  • troponin elevation

Correspondence

c1 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: poonam.punjwani@childrens.com

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