Raised cardiac troponins
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《英国医生杂志》
EDITOR—In their editorial on raised cardiac troponins Ammann et al omit an important cause of increased troponin concentration in obstetric medicine—gestational hypertension and pre-eclampsia.1
Fleming et al showed fivefold higher median values for cardiac troponin I in preeclamptic women than in normotensive pregnant women.2 These median values were above those which would be indicative of significant myocardial damage. Awareness of this becomes important in women with severe pre-eclampsia complicated by pulmonary oedema, the pathogenesis of which is likely to be multifactorial related to capillary leak, hypoalbuminaemia, hypertension, and global left ventricular dysfunction. It is also important as the other commonly used marker of myocardial ischaemia, the MB isoenzyme of creatine kinase, is raised in around a third of normal pregnant women on the first postpartum day after vaginal delivery.3
Adam Morton, endocrinologist and obstetric physician
Mater Hospital, South Brisbane, QLD 4101, Australia amorton@mater.org.au
Competing interests: None declared.
References
Ammann P, Pfisterer M, Fehr T, Rickli H. Raised cardiac troponins. BMJ 2004;328: 1028-9. (1 May.)
Fleming SM, O'Gorman T, Finn J, Grimes H, Daly K, Morrison JJ. Cardiac troponin I in pre-eclampsia and gestational hypertension. Br J Obstet Gynaecol 2000;107: 1417-20.
Leiserowitz GS, Evans AT, Samuels SJ, Omand K, Kost GJ. Creatine kinase and its MB isoenzyme in the third trimester and the peripartum period. J Reprod Med 1992;37: 910-6.
Fleming et al showed fivefold higher median values for cardiac troponin I in preeclamptic women than in normotensive pregnant women.2 These median values were above those which would be indicative of significant myocardial damage. Awareness of this becomes important in women with severe pre-eclampsia complicated by pulmonary oedema, the pathogenesis of which is likely to be multifactorial related to capillary leak, hypoalbuminaemia, hypertension, and global left ventricular dysfunction. It is also important as the other commonly used marker of myocardial ischaemia, the MB isoenzyme of creatine kinase, is raised in around a third of normal pregnant women on the first postpartum day after vaginal delivery.3
Adam Morton, endocrinologist and obstetric physician
Mater Hospital, South Brisbane, QLD 4101, Australia amorton@mater.org.au
Competing interests: None declared.
References
Ammann P, Pfisterer M, Fehr T, Rickli H. Raised cardiac troponins. BMJ 2004;328: 1028-9. (1 May.)
Fleming SM, O'Gorman T, Finn J, Grimes H, Daly K, Morrison JJ. Cardiac troponin I in pre-eclampsia and gestational hypertension. Br J Obstet Gynaecol 2000;107: 1417-20.
Leiserowitz GS, Evans AT, Samuels SJ, Omand K, Kost GJ. Creatine kinase and its MB isoenzyme in the third trimester and the peripartum period. J Reprod Med 1992;37: 910-6.