Why do troponin levels fluctuate?

Hello doctor,

I have been suffering from intense anxiety and was prescribed a daily dose of 50 mg of Sertraline to manage it.

Recently, I have been experiencing chest pain and a burning sensation in my left arm, prompting multiple visits to the emergency room. Each time, tests, including ECG, chest X-ray, and troponin I high sensitivity, came back normal. Despite this reassurance from doctors that it is not cardiac-related, the arm discomfort persists, although I am able to exercise without chest pain. Additionally, a normal echocardiogram was conducted 10 months ago, and doctors have advised against a stress test, citing my ability to climb 10 floors symptom-free.

Here is a summary of my recent ER visits:

1. Normal ECG, Troponin I hs at 8 pg/mL.
2. Normal ECG, Troponin I hs at 4 pg/mL.
3. Normal ECG, Troponin I hs at 2 pg/mL.

I am feeling extremely anxious about the fluctuating troponin levels and wondering if a drop from eight to two in a month indicates any minor heart damage or if such variation is normal. My physician does not think consulting a cardiologist is necessary. Could you please advise if a variation of approximately 6 in troponin levels over a month is typical and if it can occur in healthy individuals without indicating heart damage? Kindly help.

Thank you.

Hello doctor,

Thank you for the reply.

I do not have any hypertension or diabetes. I do not smoke or consume alcohol. My cholesterol is low. My LDL is 70. I do not have a family history of heart disease.

I am seeking reassurance regarding the fluctuation in Troponin I, which has high sensitivity levels from 8 pg/ml to 4 pg/ml to 2 pg/ml. Could this variance be considered normal? Moreover, can I confirm that there was no heart damage when my troponin levels were at 8?

The normal range for Troponin I hs, as per my report, is 0 to 20 pg/ml. I have attached the report for your reference. Kindly help.

Thank you.