Diagnosis and management of patients with acute cardiac symptoms, troponin elevation and culprit-free angiograms

Heart
Sean GallagherSaidi A Mohiddin

Abstract

Patients with acute cardiac symptoms, elevated cardiac troponin and culprit-free angiograms comprise a significant proportion of patients admitted with presumed acute coronary syndromes (ACS). International guidelines recommend that these patients receive lifelong secondary prevention under the presumption that angiographically undetectable coronary artery disease is the likeliest cause for their presentation. Recent studies using cardiac MRI suggest myocarditis to be the most common cause of these presentations. Emerging data also suggest that myocarditis presenting like an ACS may not be benign. In this article the current literature on patients presenting with acute cardiac symptoms, elevated cardiac troponins but culprit-free angiograms is reviewed, focusing on the diagnostic utility of cardiac MRI in this cohort, and the importance of diagnosing acute myocarditis. The development of higher sensitivity troponin assays will undoubtedly lead to an increase in the number of patients with presumed ACS but culprit free angiography. Robust management pathways including cardiac MRI are vital for cardiac centres dealing with these patients in order to achieve cost-effective, individualised patient care.

Citations

Dec 1, 2013·Clinical Medicine : Journal of the Royal College of Physicians of London·Laura-Ann McGill, Dudley J Pennell
Feb 2, 2015·La Revue de médecine interne·F MouquetP-V Ennezat
Oct 28, 2015·The American Journal of Cardiology·Elin B BrolinKerstin Cederlund
May 15, 2015·International Journal of Cardiology·P Stefan BiesbroekAlbert C van Rossum
Feb 24, 2015·Diagnostic and Interventional Imaging·P MontantP Douek
Aug 5, 2016·Mayo Clinic Proceedings·Gianfranco SinagraMarco Merlo
Jul 3, 2015·European Heart Journal. Acute Cardiovascular Care·Juan SanchisJulio Núñez
May 28, 2019·European Heart Journal Cardiovascular Imaging·Ahmet DemirkiranRobin Nijveldt
Oct 1, 2017·Clinical Chemistry·Martina P MarraMario Plebani
Aug 6, 2013·The Medical Journal of Australia·Derek P ChewDavid B Brieger
Feb 10, 2017·High Blood Pressure & Cardiovascular Prevention : the Official Journal of the Italian Society of Hypertension·Giacomo TiniBeatrice Musumeci
Mar 21, 2017·The International Journal of Cardiovascular Imaging·A BaritussioC Bucciarelli-Ducci
Jul 19, 2019·BMJ Case Reports·Matthew Hammond-HaleySimon R Redwood

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