ELEVATED LEVELS OF TROPONIN IN ACUTE ISCHEMIC …
ELEVATED LEVELS OF TROPONIN IN ACUTE ISCHEMIC STROKE - SILENT CORONARY ARTERY DISEASE?
J.K. Jensen, H. Mickley
Odense University Hospital, Denmark
Multiple interactions exist between the various forms of cardiovascular and cerebrovascular diseases and several risk factors for the development of stroke and major cardiovascular diseases are similar, as emphasized by the recent publication of a common set of guidelines for the primary prevention of both. Following myocardial infarction the stroke incidence is markedly increased, particular early after myocardial infarction. Additionally, non-stroke cardiovascular disease, especially coronary artery disease, is the main cause of long-term mortality in patients surviving cerebrovascular diseases. The history of ischemic heart disease in stroke patients is often unreliable because of cognitive and language impairments or simply because ischemic heart disease is asymptomatic. For at least 60 years, experimental, observational and clinical trial data have incessantly indicated that neurologically induced myocardial injury exists. After the introduction of troponin in the diagnosis of acute myocardial infarction, this marker has been measured in a number of other conditions as well. One of these conditions is acute ischemic stroke, causing diagnostic dilemmas for the clinician. Since various alterations of the electrocardiogram also have been reported in this patient category it has been suggested that elevated troponin levels are somehow neurologically mediated, thus not resulting from direct cardiac release. In conclusion, the available studies that systematically have measured troponin levels in patients with acute ischemic stroke are discussed in order to properly interpret troponin elevations in these patients.
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