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Elevated Troponin in Patients With Coronavirus Disease 2019: Possible Mechanisms

TERSALVI G, VICENZI M, CALABRETTA D, BIASCO L, PEDRAZZINI G, AND WINTERTON D.

Background:

In China the incidence of Troponin elevation was upwards of 28%, with higher elevations predicting a higher risk of ICU admission and subsequent death. Patients with a troponin elevation are more likely to be elderly and have risk factors of hypertension, coronary heart disease and/or diabetes.

 

Key Points:

 

  • Four possible mechanisms of troponin elevation are presented:
    • Myocarditis – myocardial involvement has been documented with other coronavirus species but so far not with COVID – 19 but presumed myocardial inflammation seems relatively common is likely to represent some cases of troponin elevation
    • Microangiopathy – Damage to small vessels in patients may contribute to troponin elevations along with secondary spasm and thrombotic occlusions. Contributing further is likely a secondary vasculitis that occurs in some patients with elevated troponins.
    • Myocardial Infarction – Likely occurs frequently based on other studies which suggest that plaque rupture from vascular risk or infection could be playing a role in the troponin elevations by a variety of observations.
    • Cytokyne Storm – Potentially a cause to explain the troponin increases. The patents with cytochrome storm havw significant stress on the myocardium.
  • In summary the COVID – 19 virus is very strong which allows a catecholamine surge which contributes to the risk.

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