CONGRESS ABSTRACT

Introduction: Supraventricular tachycardia (SVT), perceived by the patient (pt) as a feeling of palpitations and chest pain, is often associated with repolarization alterations (ST segment depression) that may suggest, together with the symptom "chest pain", the co-presence of cardiac ischemia. However, the relationship between such alterations and the actual presence of cardiac ischemia is poor. Therefore, the ESC guidelines on chronic coronary syndromes recommend not taking into account such repolarization alterations (class III). Our case highlights how, not only the repolarization alterations, but also the increase in troponin, even if elevated, is of very little use in predicting the co-presence of ischemic heart disease in this contest Clinical case: A 56-year-old woman arrives in the Emergency Department (ED) for palpitations and chest pain. In her anamnesis she presents acquired post-surgical hypothyroidism (thyroid removal in 2005 for differentiated thyroid carcinoma) in replacement therapy (currently in euthyroidism). She also reports, for about 20 years, brief episodes of palpitations and shows a Holter EKG from 2023 in which sporadic supraventricular ectopic beats and a brief SVT are highlighted. No known cardiovascular risk factors are highlighted. On the EKG: SVT at 195 b/min with marked ST segment depression. Systolic blood pressure 70 mmHg. Vagal maneuvers ineffective. Adenosine 6 mg is administered ineffective and then 12 mg which allow the restoration of sinus rhythm. During observation in the ER, a significant increase in troponin I is observed 52.5 ng/L -> 3433 -> 3775 -> 1460 with a bell-shaped trend. Substantial normality of the other blood tests and Echocardiography. Despite the patient's asymptomatic nature, given the significant increase in troponin, it was decided to hospitalize her in cardiology and perform a coronary angiography which showed healthy coronary arteries. After 2 days from presentation in the ER, the patient was discharged on bisoprolol therapy and with an outpatient re-evaluation program. Conclusions: The usefulness of measuring troponin during SVT is at least questionable and should be strongly limited. Even a high increase in troponin during SVT should not be considered a sign of ischemic heart disease and should not be used as a criterion for deciding whether or not to hospitalize the patient