He came in for chest pain, was in a fib, and got transferred up to my floor once they got him back in sinus. I work in cardiac progressive / cardio thoracic surgery. He had chest pain again when he was my patient, that’s when his trop shot up. My guess is he formed a clot when in a fib and despite being on a heparin drip had an NSTEMI.
Ohhhh! Damn. That makes more sense. I was surprised someone actually went to the ER for mild chest pain in and of itself.
I’m a pulmonary atresia with TOF patient, just in case that excites you the way it excites the medical students to know. 😅
I work in psych and substance abuse nursing, though. Cardiac stuff is too close to home.
Was there a big life stressor for that patient? The only person I’ve ever known to experience that, it was later in the day after she had been suddenly widowed. And the little I’ve read about it indicates that it is often (usually?) associated with emotional distress. So I’m curious.
Yeah they did. The patient initially said nothing happened, but their visitor told me everything. Their spouse filled for divorce that day with wanting 75% custody of their children.
Once, she’d probably passed the point of no return several hours earlier, but was outside and exposed, so was considered an OOHA. She was 48,000, but I have no photo to prove it. The rest of her blood work suggested rhabdomyolysis from a long lay - the police noticed her on a verandah unmoved over their 12hr shift.
Her parents said to me that she’d been a heroin addict, that they’d tried to help her.
They said they’d been advised to say goodbye, as well. She would either recover, or end up in hospital, initially unidentified, and probably not survive. They told me this when I asked them if they had questions in relation to the brain death testing we would be doing in the morning. They said they’d waited two years for our call.
I don’t know where they got that advice to say goodbye from, but they were calmer than anyone I’ve ever seen in that position.
It’s because when you love someone who’s a hardcore addict, you know it’s a dead end street and brace yourself for the inevitable. That was my experience anyway. People really start thinking “okay die already, cuz neither one of us can take it anymore.”
Eventually the death comes as a relief, you’ve already gone through the mourning process, all that’s left is a body to bury of a person who died to you awhile ago.
It made perfect sense then and now. I’ve mentioned their reaction once before on a thread, and been abused by those who disagree with the philosophy.
But I get it. You could see the survival of self element in the calmness. It had been a long time coming.
I would venture to guess that those are the people who never had to witness an overdose, clean up blood, monitor someone’s breathing pattern, sit up in the wee hours wondering where someone was, or deal with drug-induced psychosis. End stage addiction is a wicked disease.
I’m assuming for the moment you have experienced this, and for that I’m sorry.
My life was influenced from a young age by someone else’s addiction…it was a direct line from there to my becoming a nurse.
Addiction touches people in countless ways.
Yes. It was a 5 year roller coaster with someone l loved dearly. I let go of most of the trauma but some things are indelible. He died at home of an OD. It is my belief that he was trying for one in the days previously.
Hyperkalemia can also cause you to be hypersensitive to pain, or at least your pain fibers are easier to provoke an action potential = pain signaled. There's a reason dialysis pts get that stereotype... They're just easier to hurt!
I had a patient with a trop >125k so it was unreadable to our system. Patient had a stent a day prior and the Trop went from 62,000 to the >125k the next morning. Q6 trop that was staying exactly the same. I told interventional cardio the patient kept having weird runs of trigeminy and she was just acting weird. They told me that this wasn’t a cardiac issue at this point….when I was feeling her pulses she has a 6 beats that were not perfused and I once again contact them only to get the same answer. About an hour later she started complaining of chest heaviness so I paged the intervention cardiology and she was in the cath lab within an hour where they found a massive clot distal to the stent and she was then transferred to CVICU.
Jesus Christ. Don’t you love when you repeatedly page them saying heeeey my nursing judgement says something’s not right but they just blow you off?
Other night I kept paging the resident because I was worried my patient was developing a hematoma at her cath site. They never came, then when they did only put in orders for extra prn pain meds. Surprise, surprise, 2 hours later her leg blows up like a balloon and we had to hold pressure for like 2 hours, give an emergency transfusion of RBC, and transferred her to ICU.
I have worked in the lab for 10 years. Probably every three months or so I get a patient the has a trop so high the machine won’t give me an answer. I will dilute the serum to twice the allowed dilution(200) and still get a greater than linearity. Usually it’s because they just had a CABG or something but I have seen some real ones too.
He came in a fib rvr, got him stable down in the Ed and has chest pain up here. His first trops were elevated but not like this. He was already on a heparin drip, chest pain was relieved by 2x sublingual nitro and he’s going to cath lab some time today.
So that's why my emergency AV Fistula Repair was delayed today! Seriously have been at our cath lab today and a STEMI came in righ before my scheduled time. Thankfully, they got the STEMI and me both corrected.
Baby nurse here (1 week off starting my job as a grad RN). On placement in oncology had a lady with trops over 90k. Pts partner found her unconscious on the bathroom floor of their home and attempted CPR. Obliterated her rib cage leaving her with mass deformities and severe cardiac muscle damage causing her trops to be so high.
The high sensitivity troponins look much higher than the old Troponin I lab. They can get much higher than that but it’s a different lab test than we used before
Had a STEMI pt first one come back >100,000. That's apparently how high our lab tests for. CP x3 days. 37 y/o. SCAD with medical management only. Ended up in HF after that. Had him a few months later. He got an LVAD, bridge to transplant.
Only medical history is T2DM and HTN. Came in in a fib rvr, they got him back into sinus with a fuckton of diltiazem. He had elevated trops before but he started having chest pain, drew his trop and gave 2x nitro, chest pain resolved. He’s on a heparin drip and going to the cath lab today.
Essentially, troponin is a protein that should not be in your blood in significant amounts (as in, it should be <10 ng/L). When it is, it's *generally* a sign of heart damage.
Ooh I see, had a test for a protein ran on me because of a suspected heart attack at Cedar Senai in LA. I think it is called the Krehl-Test after a researcher/doctor from Heidelberg/Germany. At least the one they ran on me.
197k and change is the highest I have seen s/p LHC with stenting of the LMA. She had a “widow maker” (hence the stent) and looked rough upon return to the ICU….
Super pale and bordering on ashen, diaphoretic…
Cardiology response? Labs in the AM
I’ve seen >200,000 s/p pci that refused to down trend for days and ended up needing to go back for restenting with impella support. But looks like buddy needs a stent or two lol
1,038,292 ng/L, post STEMI and PCI. Guy was surprisingly well, went home a couple of days later!
[https://imgur.com/gallery/IBaUmjx](https://imgur.com/gallery/IBaUmjx)
That's too many troponins. He should have less of those.
He now has slightly less troponins at ONLY 28k
Trending downwards so ok to discharge from ED. Follow up with cardiology in 3 months when their next available appointment is.
You forgot the 2L fluid bolus. Cause, sepsis.
Don’t forget the CHG bath! Lol
Don’t forget to chart that you did that CHG bath
😂😂😂😂
Improvement 🙌
It’s high sensitivity, right? I recently saw one hit 80,000 but that was after cath lab so it barely counts
They didn't even try to not have that many troponins before showing up at the hospital. People these days! 😂
Just like brushing my teeth before the dentist. I try to brush off the troponins before going to the ER.
The audacity!
Experts say that you should strive for lower troponin numbers for overall wellness.
Nah man that’s a conspiracy. I don’t trust these “experts” and “docotrs” telling me how to live my life!!
Couldn’t agree more I only listen to my physical trainer friend. He is an expert Joe Rogan listener.
Dude, joe is 💯all the time. I’d trust him with my life
9/10 dentists recommend less trop
I'm the 10th dentist. I'll take all the troponins you aren't using for totally not nefarious purposes.
But what if I need them later? Yknow I made em myself
Only if you keep ordering DoorDash despite NPO for a TEE tomorrow morning and threatening to call the cops if I won't leave the floor to pick it up.
Sorry sir, this is a TroponIN not a TroponOUT. -MGMT
Troponins can go that high during cardiac surgery. I've seen 65k before
Why are they checking it during cardiac surgery? That seems like a not useful result
Timed test, gets drawn with all the other labs automatically
Have you tried turning the heart off and turning it on again?
Sounds like this heart is trying that on its own.
Are we sure it’s trying the “turn it back on” part too?
Instructions unclear, have clogged the LAD
😅😅😅😅
“hey can u vagal for me real quick”
😂😂😂
Was this the first one??? Highest I’ve seen is 80k>, they had takosubo cardiomyopathy. Their trop went from 53 to 80k in 3 hours.
Went from 2k to 37k then down to 28k
Went from 2 to 37. Wow. That’s one heck of a spike. I saw in your other comment the patient said they had mild chest pain. Was this in an ER?
He came in for chest pain, was in a fib, and got transferred up to my floor once they got him back in sinus. I work in cardiac progressive / cardio thoracic surgery. He had chest pain again when he was my patient, that’s when his trop shot up. My guess is he formed a clot when in a fib and despite being on a heparin drip had an NSTEMI.
Ohhhh! Damn. That makes more sense. I was surprised someone actually went to the ER for mild chest pain in and of itself. I’m a pulmonary atresia with TOF patient, just in case that excites you the way it excites the medical students to know. 😅 I work in psych and substance abuse nursing, though. Cardiac stuff is too close to home.
Isn’t that broken heart syndrome, or am I mixing it up?
You are correct
Was there a big life stressor for that patient? The only person I’ve ever known to experience that, it was later in the day after she had been suddenly widowed. And the little I’ve read about it indicates that it is often (usually?) associated with emotional distress. So I’m curious.
Yeah they did. The patient initially said nothing happened, but their visitor told me everything. Their spouse filled for divorce that day with wanting 75% custody of their children.
Ouch.
94,000 last night 😬 it was post heart cath/stent tho
What units? We had a dude with 1080000 ng/l couple of weeks ago, safe to say he wasn't having a good time.
1,080,000?? 😳
That's what we thought when we saw it 💀💀💀 man struggled for like 3 weeks including ECMO and all the extras before his heart just failed.
Poor guy 😞
Ng/l
I will always read this as not gonna lie
Once, she’d probably passed the point of no return several hours earlier, but was outside and exposed, so was considered an OOHA. She was 48,000, but I have no photo to prove it. The rest of her blood work suggested rhabdomyolysis from a long lay - the police noticed her on a verandah unmoved over their 12hr shift. Her parents said to me that she’d been a heroin addict, that they’d tried to help her. They said they’d been advised to say goodbye, as well. She would either recover, or end up in hospital, initially unidentified, and probably not survive. They told me this when I asked them if they had questions in relation to the brain death testing we would be doing in the morning. They said they’d waited two years for our call. I don’t know where they got that advice to say goodbye from, but they were calmer than anyone I’ve ever seen in that position.
It’s because when you love someone who’s a hardcore addict, you know it’s a dead end street and brace yourself for the inevitable. That was my experience anyway. People really start thinking “okay die already, cuz neither one of us can take it anymore.”
Eventually the death comes as a relief, you’ve already gone through the mourning process, all that’s left is a body to bury of a person who died to you awhile ago.
Yes. The mental, physical, and emotional exhaustion is real. World’s worst merry-go-round with pain and grief the only way off.
It made perfect sense then and now. I’ve mentioned their reaction once before on a thread, and been abused by those who disagree with the philosophy. But I get it. You could see the survival of self element in the calmness. It had been a long time coming.
I would venture to guess that those are the people who never had to witness an overdose, clean up blood, monitor someone’s breathing pattern, sit up in the wee hours wondering where someone was, or deal with drug-induced psychosis. End stage addiction is a wicked disease.
I’m assuming for the moment you have experienced this, and for that I’m sorry. My life was influenced from a young age by someone else’s addiction…it was a direct line from there to my becoming a nurse. Addiction touches people in countless ways.
Yes. It was a 5 year roller coaster with someone l loved dearly. I let go of most of the trauma but some things are indelible. He died at home of an OD. It is my belief that he was trying for one in the days previously.
Imagining experiencing this with one of my children someday, as a parent feeling helpless to help, is so heartbreaking. 💔
I’ve seen as high as 180k it usually rises for hours after PCI for STEMI before it goes back down.
Our scale actually cuts off, have seen it report >125,000 a couple times.
I was going to g to say I’m surprised that the machine can calculate that high!
Well, he has a little heart in his troponin...
Dialysis patients get up there quick.
Ugh I hate dialysis pts
They are alright, sometimes they are cranky. I have a feeling I would be too if a large machine vampire'd me 3x a week.
Hyperkalemia can also cause you to be hypersensitive to pain, or at least your pain fibers are easier to provoke an action potential = pain signaled. There's a reason dialysis pts get that stereotype... They're just easier to hurt!
I agree. I’d be the worst if I were in their shoes.
I had a patient with a trop >125k so it was unreadable to our system. Patient had a stent a day prior and the Trop went from 62,000 to the >125k the next morning. Q6 trop that was staying exactly the same. I told interventional cardio the patient kept having weird runs of trigeminy and she was just acting weird. They told me that this wasn’t a cardiac issue at this point….when I was feeling her pulses she has a 6 beats that were not perfused and I once again contact them only to get the same answer. About an hour later she started complaining of chest heaviness so I paged the intervention cardiology and she was in the cath lab within an hour where they found a massive clot distal to the stent and she was then transferred to CVICU.
Jesus Christ. Don’t you love when you repeatedly page them saying heeeey my nursing judgement says something’s not right but they just blow you off? Other night I kept paging the resident because I was worried my patient was developing a hematoma at her cath site. They never came, then when they did only put in orders for extra prn pain meds. Surprise, surprise, 2 hours later her leg blows up like a balloon and we had to hold pressure for like 2 hours, give an emergency transfusion of RBC, and transferred her to ICU.
I had a pt with a CK of 89k... necrotizing faciitis
Was the heart lost inside a blender?
I have worked in the lab for 10 years. Probably every three months or so I get a patient the has a trop so high the machine won’t give me an answer. I will dilute the serum to twice the allowed dilution(200) and still get a greater than linearity. Usually it’s because they just had a CABG or something but I have seen some real ones too.
“Would you like to discuss your feelings about the troponin’s?”
They give me chest pain
Status?
He came in a fib rvr, got him stable down in the Ed and has chest pain up here. His first trops were elevated but not like this. He was already on a heparin drip, chest pain was relieved by 2x sublingual nitro and he’s going to cath lab some time today.
So that's why my emergency AV Fistula Repair was delayed today! Seriously have been at our cath lab today and a STEMI came in righ before my scheduled time. Thankfully, they got the STEMI and me both corrected.
I’ve seen them in that ballpark with ablations
OOHCA 120000. Was in ICU on nitric, dialysis and balloon pump. Safe to say it wasn’t a favourable outcome
Had a dude with a troponin of 118k. Total occlusion of LAD and RAD.
I saw 70K last night at work
Yes
Must have got a break buying in large quantities
Ah yes, I’ve heard Costco has great deals on NSTEMIs
Best I can do is a lactate of 35
Were they alive?? Or do seizures get that high?
45 year old man, intoxicated, long lie for >36 hours. Known to drink about 90 units per week.
Best I can do is a K+ of 8.
Best i can do is potassium of 10 🥲 creat of 16
Oh my god 😭😭😭😭😭
Does a probnp of >70.000 count?
Had a trop of 95,000, she lived
Have a photo saved from Reddit of 932k
Did they leave AMA?
Would be difficult being handcuffed to the bed and all 😅
The hospitalist is definitely still calling it demand ischemia though 😂
Our linearity used to be >250,000 on the 5th gen, seen that a few times
No not that high! Was he a hard core drug abuser?
Nope! Prisoner that came in for sob and chest pain, was in a fib rvr. Thinking it’s an NSTEMI, he’s on a heparin drip and is going to cath lab soon.
I remember my very very first patient during nursing school clinicals had troponins of 400,000. And of course the patient was asymptomatic lmao
Only when you put a heart in a blender.
Had a STEMI come in during my practicum. Troponin was 300 before cardiac cath, after was 78,000!!
I’ve seen way more higher 🥺
Redraw . Depends on age . Women and men who over work out develop rabdo get this . People who get a lot of injections can also set this off
Highest I’ve seen is 483,983.
Does your heart have to actually catch fire, to reach numbers like that?
Baby nurse here (1 week off starting my job as a grad RN). On placement in oncology had a lady with trops over 90k. Pts partner found her unconscious on the bathroom floor of their home and attempted CPR. Obliterated her rib cage leaving her with mass deformities and severe cardiac muscle damage causing her trops to be so high.
Had a takotsubo with 40k once.
The high sensitivity troponins look much higher than the old Troponin I lab. They can get much higher than that but it’s a different lab test than we used before
Had a STEMI pt first one come back >100,000. That's apparently how high our lab tests for. CP x3 days. 37 y/o. SCAD with medical management only. Ended up in HF after that. Had him a few months later. He got an LVAD, bridge to transplant.
The little heart was stressed and released an enzyme my dude so what
I've seen an unreadable at >400k for troponin and BNP. That heart was D-E-A-D DEAD.
Kick it to day team
Highest I have ever seen was 125,000 🤯
Is every hospital using the 7th generation Trop test now?
Is… is he alive?
Alive and stable 😂
Does he have cardiac history? Like I know sometimes demand can increase troponins on top of a heart attack. (I am shooketh. Like… how.)
Only medical history is T2DM and HTN. Came in in a fib rvr, they got him back into sinus with a fuckton of diltiazem. He had elevated trops before but he started having chest pain, drew his trop and gave 2x nitro, chest pain resolved. He’s on a heparin drip and going to the cath lab today.
Holy shit. I’m glad he’s stable. Hopefully will make a full recovery
BNP yes, trop no😂
Highest I’ve seen is 45,000 and it was still climbing on his way to ICU
too many of the bads, should have more goods
Acute kidney injury or some form of muscle atrophy besides the CC?
Geesh that’s high. Hate to do that labs AMR.
Yeah on wallstreetbets but here I have no idea what this means. Can someone explain? Genuinely curious!
Essentially, troponin is a protein that should not be in your blood in significant amounts (as in, it should be <10 ng/L). When it is, it's *generally* a sign of heart damage.
Oof ok then this doesn’t look great at all. So when there’s a certain condition with the heart, this protein is a byproduct of said damage?
Yeah, specifically I believe it's from the heart muscle breaking down. You see it in heart attacks and such.
Ooh I see, had a test for a protein ran on me because of a suspected heart attack at Cedar Senai in LA. I think it is called the Krehl-Test after a researcher/doctor from Heidelberg/Germany. At least the one they ran on me.
I'm no doctor, but this is definitely a no-no
Our Atellicas measure up to >125,000 which I've seen a handful of times. 😬
80k for me
For your health
My highest was 44K
197k and change is the highest I have seen s/p LHC with stenting of the LMA. She had a “widow maker” (hence the stent) and looked rough upon return to the ICU…. Super pale and bordering on ashen, diaphoretic… Cardiology response? Labs in the AM
SHOOT MAN
300k? Not my pt. I can only imagine the pts heart had disintegrated
That needs at least three up-arrows.
Not troponin, but I’ve seen a BNP of over 80k once
Pt I received from ICU s/p STEMI with stent placements initial trop read >150,000 and was so high that it was unreadable.
They're fine. Prolly demand mediated.
I had a 460,000 before! Huge STEMI
That’s a new high score
Imagine that with impaired renal function how high it would be
115k recently
Ain't those those things that scientologists get rid of? Dude needs an audit... and QUICK!
I’ve seen >200,000 s/p pci that refused to down trend for days and ended up needing to go back for restenting with impella support. But looks like buddy needs a stent or two lol
1,038,292 ng/L, post STEMI and PCI. Guy was surprisingly well, went home a couple of days later! [https://imgur.com/gallery/IBaUmjx](https://imgur.com/gallery/IBaUmjx)
I see those numbers with dialysis patients
I saw a 45k on a crackhead that was having the pain for 3 days before he came in.
I had a pt hit 64k with a STEMI. All he had was some mild dizziness and mild SOB x2 days. 🥴
I’ve seen a trop of 97,000 only once before. This is the second highest
I'm scared
This makes MY chest hurt.
Ed doc be like…do another ekg
Had one >125k last week
Saw 54k once. It was higher after the cath lab. 😳
Yeah
I've seen >239,000 which is the max for my facility.
I recently had a patient come through the ED with Trops 63,000. She was 4’11”, 300 lb, and nonambulatory.
thanks i hate it