troponin bump

The Scourge of Troponipenia

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MIAMI-DADE COUNTY, FL – Hospitalists are going crazy about the pandemic of normal troponins in Miami-Dade.  Jose Fernandez-Rodriguez-Hernandez-Alonso, MD — “Mrs. Garcia, presented with chest pain, it was sharp, started after an especially traumatic episode of her favorite telenovela.

troponinPer Mrs. Garcia ‘I am in agony, aqui y aqui y aqui – total body dolor!, it is 200 out of 10, worst pain of my life’. It was so bad, that she broke down in tears.” Yes, the EKG was normal, yes, her LDL was as high as 28, and yes it was reproducible in every part of her chest, back, arms, and legs, BUT there was no way that this could not be a heart attack.”

The first set of troponins was 0.01. There was a glimmer of hope, “Detectable”, the cardiology fellow was summoned immediately to the scene.

But…the aloof cardiologist requested a second set prior to a full evaluation.

As the hours went by, the second set was surprisingly “Undetectable”. Mrs. Garcia, was losing her mind from the anguish. Dr. Fernandez-Rodriguez-Hernandez-Alonso attempted to palliate the suffering with “healthy” doses of vitamin Dilaudid.

As the third set rolled out at <0.01, Dr. Fernandez-Rodriguez-Hernandez-Alonso called the laboratory, concerned about the QI/QC of the equipment, there was no way that this troponipenia was real.

As the astute hospitalist battled the lab on the validity of this troponipenia, Mrs. Garcia, moaned away, slowly slipping into a comatose euphoria.

Having established, in triplicate that the troponipenia was not a mistake, Dr. Fernandez-Rodriguez-Hernandez-Alonso turned to the cardiologist for answers.

“What are we going to do?? This woman is suffering, it has to be her heart, damn the troponipenia, I cannot do anything without you.”

The fellow evaluated the patient, his note was brief, “this is non-cardiac, I appreciate your interesting consult, thank you for allowing me to care for your patient.”

In exasperation, Dr. Fernandez-Rodriguez-Hernandez-Alonso was forced to call a rapid response on his now-comatose Mrs. Garcia.

Though everyone recovered, this case of troponipenia remains a mystery. Dr. Fernandez-Rodriguez-Hernandez-Alonso referred Mrs. Garcia for further outpatient workup on discharge, stating that “troponipenia is a plague on our patients and society; a burden that cannot be ignored by the cardiology community, we must address this pandemic before it is too late.”

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