According to the World Health Organization, the diagnosis of acute myocardial infarction (AMI) is based on two of the three main criteria: changes in the ECG (up to 25% of myocardial infarctions are not reflected in the ECG), anginous pain, and increased markers of myocardial necrosis. In 2000, the European Scientific Society and the American College of Cardiology made a correction to the definition of AMI, according to which the determining factor in the diagnosis of AMI is the detection of an increased level of specific markers of myocardial necrosis — cardiac troponins in the blood. Troponin is a protein that is part of myofibrils. Cardiac troponin contains three subunits: T, I, and C. Troponin C is non-specific for the myocardium, in contrast to the T and I subunits, whose structure in the contractile fibers of cardiomyocytes differs from similar proteins of other muscle cells. The widespread use of the determination of cardiac troponins in the blood significantly increased the detection of AMI (by 30-200%). Until recently, it was believed that troponins enter the blood only as a result of the death of cardiomyocytes. However, in recent years, it has been shown that troponins can penetrate into the interstitial space, and then into the blood, when cardiomyocytes are damaged with an increase in the permeability of their cell membranes, which can be caused not only by AMI, but also by conditions accompanied by hyper production of pro-inflammatory cytokines (tumor necrosis factor-a, interleukin-1, etc.). The aim of this study was to analyze the final diagnoses in patients with increased cardiac troponin-T levels without a clinical picture and characteristic ECG changes in AMI.
acute myocardial infarction, cardiomyocytes, cardiac troponin-T, anginous pain
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