Could an LAD bridge with extreme exercise induce an elevated troponin level?

ER visit for chest pain – Troponine levels were very elevated but dropped over 6 hours. Follow up testing: electrocardiogram, ultrasound and CT scan with contrast and nitroglycerine were normal with the exception of a cardiac bridge. Chest pain continues on and off at rest and exercise. I am an endurance athlete with resting pulse 41 bpm, no cholesterol issues and no cardiac risk factors aside from age – 50. Could bridging with extreme exercise induce elevated troponine? Does ongoing chest pain warrant further evaluation and/or reduction in physical activity? Also wondering what would trigger this if bridge is a congenital in nature. Am in military/VA medical system and have yet to actually see a doctor or cardiologist in person to discuss or get questions answered. They order tests and a nurse calls with results. Concerned and frustrated. Thanks.

Submitted by Sue from Virginia on 07/13/2015

by Patrick J. Cook, MD

I’m assuming the “CT” was a CT angio of the coronaries which showed no coronary artery occlusive disease of note. A bridge CAN cause symptoms, but uncommonly, and the same goes for troponin. To see if the bridge is causing exercise induced chest pain, a stress test, preferably a nuclear stress test or stress echo, would be appropriate. A bridge is unlikely to cause resting symptoms.