Heart Stroke! Elevated Troponin T and Global T-wave Changes in an Acute Ischemic Stroke
Avinsesh Bhar, M.D. Aisha Khalid, M.D. M. Rizwan Khalid, M.D. Steven Reichert, M.D., F.A.C.P.
A 78-year-old Asian female with a history of hypertension and DM type II presented to NYHQ after having collapsed following a sudden onset of right-sided weakness.
Her vitals were noted as follows: blood pressure 123/52mmHg and heart rate of 61bpm. On the CNS examination she had a right facial droop with expressive aphasia and complete right hemiparesis. Babinski’s sign was present on the right lower extremity. Cardiovascular examination was unremarkable.
Initial CT of the head revealed no acute cerebral pathology and she was scored at 8 on the NIH stroke scale. Her labs were significant for a troponin T of 0.069ng/mL, serum creatinine of 0.8 mg/dL (GFR >60ml/min) and CPK level was normal. There was no previous cardiac history. The ECG on admission (Figure 1) was significant for T-wave inversions in leads V5 and V6. The patient was treated with simvastatin 40mg daily and aspirin/dipyridamole twice a day.
An MRI of the Brain (Figure 2) revealed an acute infarct of the left middle cerebral artery territory with mass effect.
An Echocardiogram was done showed normal systolic and diastolic function without wall motion abnormality. ECG on day 4 (Figure 3) showed diffuse T wave inversions and a prolonged QT interval of 0.60s, which increased to 0.72s on Day 10 (Figure 4).
The family declined any further intervention and a DNR order was signed. The patient was transferred to a skilled nursing facility where she expired one week later.
ECG changes may be seen in acute stroke patients without any associated myocardial damage; however, this may represent a cohort of patients with myocardial injury not detected on routine cardiac evaluation. These ECG changes are also significant because they are associated with an increased incidence of malignant arrhythmias and sudden death.
Troponin T is a sensitive and specific marker of cardiac damage. Elevated serum troponin T on admission is a strong predictor of mortality in patients with an acute ischemic stroke. Thus, serum troponin may conceivably be utilized to predict prognosis in these patients.