Dr Evangelos Giannitsis
Cardiologist, Medical Director of Chest Pain Unit, University Hospital of Heidelberg, Germany

Clinical Cases: Diagnostic relevance of elevated hs-cTnT

Case   69-year old man
Key signs and symptoms Acute left-sided chest tightness/discomfort at rest for the past 8 hours, duration 30 – 40 minutes, brief symptom-free phases
Exertional dyspnoea for several months
Medical history/
Clinical examination
Peripheral arterial occlusive disease (PAOD) IIa bilateral, walking distance 270 m, active smoker, arterial hypertension, hypercholesterolaemia
Laboratory test
Result   Reference range
CRP 9 mg/dL   < 5 mg/dL
GFR 55 mL/min/1.73 m2   >90 mL/min/1.73 m2
Leukocytes 9.2/nL   4.4 – 11.3/nL
D-dimer 1.3 mg/dL   < 0.5 mg/dL
NT-proBNP 250 ng/L   < 300 ng/L to rule-out acute heart failure (AHF) and >900 ng/L heart failure (HF) likely if 50–75 year-old (confirmation with imaging)
Characteristic ECG with ST segment depression in the lateral leads.
Troponin kinetic profile   image
Coronary angiography   image
Dr Giannitsis Clinical Case - 1

What is the diagnosis of this case?

Acute myocardial infarction/NSTEMI
According to the universal definition, the diagnosis of AMI is confirmed:
The cTnT-hs concentration within 24 hours of the index event was above the 99th percentile cut-off value (14 ng/L) on at least one occasion
A typical rise and fall in the cTnT-hs levels was also observed
The clinical criterion for myocardial ischemia is fulfilled by the typical angina pectoris symptoms and ECG changes
Coronary angiography shows high grade stenosis of the ramus interventricularis anterior / Ieft anterior descending artery (RIVA / LAD)
All three criteria for an acute myocardial infarction are satisfied: elevated cTnT-hs level, typical kinetic of cTnT-hs release and clinical presentation with ECG changes.

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