From the Guidelines
Troponin testing is essential for patients with food bolus impaction to rule out cardiac ischemia, as it can help differentiate between esophageal pain and actual cardiac damage, particularly in older patients or those with cardiovascular risk factors, as supported by the most recent guidelines 1. The primary reason for performing troponin tests on patients with food bolus impaction is to exclude cardiac ischemia that may have occurred during the choking episode or as a complication of the impaction. When a food bolus becomes lodged in the esophagus, patients often experience chest pain, which can mimic cardiac chest pain. Some key points to consider when evaluating patients with food bolus impaction include:
- The physiological stress of choking, including hypoxia, increased sympathetic tone, and the Vagal response, can potentially trigger cardiac events, especially in patients with pre-existing coronary artery disease, as noted in the universal definition of myocardial infarction 1.
- Troponin is a cardiac-specific protein released into the bloodstream when heart muscle is damaged, making it an excellent biomarker for myocardial injury, with high-sensitivity assays able to detect measurable troponin levels even in healthy individuals 1.
- By measuring troponin levels, clinicians can differentiate between esophageal pain from the food impaction and actual cardiac damage, which is crucial for determining the appropriate course of treatment, as emphasized in the guidelines for acute coronary syndromes 1.
- Troponin testing should be considered especially if the patient reports chest pain, has risk factors for coronary artery disease, or if the impaction has been prolonged, as these factors increase the risk of cardiac complications, as highlighted in the study on the practical implementation of guidelines for unstable angina/non-ST-segment elevation myocardial infarction 1.
From the Research
Troponin Measurement in Patients with Food Bolus
- Troponin is a sensitive marker of myocardial injury and is used to establish the diagnosis of myocardial infarction (MI) 2, 3.
- The measurement of troponin is crucial in patients with suspected MI, as it helps to identify those who require anti-thrombotic therapy to limit myocardial damage and preserve cardiac function 2.
- However, troponin can also be elevated in other conditions, such as myocardial injury, pericarditis, and pulmonary embolism, which can make diagnosis challenging 3, 4.
Clinical Significance of Troponin in Food Bolus Obstruction
- There is limited evidence on the use of troponin in patients with food bolus obstruction, and it is not a standard practice to measure troponin in these patients 5.
- However, in some cases, patients with food bolus obstruction may experience chest pain or other symptoms that could be mistaken for MI, and troponin measurement may be useful in ruling out MI 6.
- The quality criteria of the troponin test, such as sensitivity, specificity, and positive predictive value, can vary depending on the clinical context and leading symptoms 6.
Diagnostic Challenges
- The diagnosis of MI or myocardial injury in patients with food bolus obstruction can be challenging, and troponin measurement should be interpreted in the context of clinical symptoms and other diagnostic tests 4, 6.
- The use of high-sensitivity troponin assays can improve diagnostic accuracy, but it is essential to consider the clinical context and potential alternative causes of troponin elevation 2, 3.