The prevalence of cardiovascular diseases, such as heart attacks, is rapidly increasing worldwide. With this growing concern, it's crucial to detect problems early and have effective ways to manage them. Diagnosing a heart attack starts with identifying the symptoms and quickly seeking medical attention. We spoke to our expert, Dr C Raghu, Clinical Director and Senior Interventional Cardiologist, Yashoda Hospitals, Hyderabad, who provided insights into blood tests that can aid in detecting a heart attack.
According to the American Heart Association, a heart attack, also known as a myocardial infarction or simply an 'MI', occurs when a blockage in one or more coronary arteries decreases or halts blood flow to the heart. This deprivation of oxygen to a section of the heart muscle leads to a heart attack.
Importance of Chest Pain Evaluation
Chest pain is one of the most common reasons for seeking medical advice, especially under emergent circumstances. “The rising prevalence of heart attacks, even among younger individuals, leads many to seek evaluation in hospital emergency rooms. Exclusion of a heart attack diagnosis is essential for the person to be disposed of from the hospital”, said Dr Raghu. Avoiding unnecessary hospitalisation and investigations saves time, and money, and prevents psychological trauma.
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Evolution of Diagnostic Modalities
“In the past, the Electrocardiogram (ECG) was the main test for the diagnosis or exclusion of heart attacks. However, ECG remains non-diagnostic in nearly 20% of cases, and special clinical skills are required for its interpretation”, said Dr Raghu. To overcome the limitations of the ECG, novel diagnostic modalities have emerged for the diagnosis and exclusion of heart attacks.
He added, “High-sensitivity troponin is a landmark investigation that plays a pivotal role in the emergency management of chest pain. Compared to previous generations of troponin assays, the high-sensitivity troponin blood test detects heart attacks, and minor heart attacks, and can detect a heart attack early, within 90 minutes.” Being a blood test, it doesn’t require extraordinary clinical abilities to interpret, and elevated high-sensitivity troponin indicates damage to the heart muscle.
Troponin, a protein present in heart muscle cells, is released into the bloodstream when these cells are harmed. The troponin test assesses the protein levels in the blood. Increased troponin levels strongly suggest a heart attack. According to the American College of Cardiology, troponin testing is advised when symptoms are present, followed by another test 3–6 hours later.
Role of High Sensitivity Troponin
For patients who present with chest pain in the emergency room, if the ECG reveals classical changes of a heart attack, there is no requirement to perform high-sensitivity troponin for diagnosis and instead proceed directly for heart attack treatment.
“For those without ECG changes and the absence of clinical features of a heart attack, the value of troponin is negligible. Troponin remains extremely useful when the ECG changes or chest pain are not typical of a heart attack, and one needs to exclude a heart attack diagnosis”, added Dr Raghu.
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Clinical Application and Interpretation
Dr Raghu said, “When high-sensitivity troponin is performed twice, separated by a gap of one hour, and both reports are normal, the diagnosis of a heart attack can be safely excluded. Also, the magnitude of troponin elevation indicates the severity of heart muscle damage, which has an important bearing on heart attack outcomes.”
High-sensitivity troponin has revolutionised the emergency management of heart attacks and the test emerged superior as well as complementary to traditional investigations, such as ECG, echocardiography, and coronary angiogram.
[Disclaimer: This article contains information provided by an expert and is for informational purposes only. Hence, we advise you to consult your expert if you notice any symptoms of heart attack to get the necessary treatment.]