Can T boli (Troponin bolus) be elevated in colitis?

Troponin Elevation in Colitis

Yes, troponin can be elevated in colitis due to systemic inflammation, though this is not a common finding and should prompt consideration of other cardiac etiologies. 1

Mechanisms of Troponin Elevation in Colitis

Troponin elevation in colitis can occur through several mechanisms:

1. Systemic Inflammatory Response:

   • Severe colitis can trigger a systemic inflammatory response with release of pro-inflammatory cytokines (TNF-α, IL-6, IL-8) that may cause myocardial injury 2, 3
   • This inflammation-mediated cardiac injury can occur without primary coronary artery disease

2. Medication-Related Cardiac Effects:

   • Some medications used to treat colitis, such as mesalazine, can rarely cause myopericarditis as an adverse effect 4
   • This can present with chest pain, ECG changes, and troponin elevation

3. Severe Disease with Multi-Organ Dysfunction:

   • In acute severe colitis, significant inflammation can lead to multi-organ involvement including cardiac injury 1

Clinical Approach to Troponin Elevation in Colitis Patients

When encountering elevated troponin in a patient with colitis:

Step 1: Assess Colitis Disease Activity

• Evaluate clinical symptoms: stool frequency, rectal bleeding, abdominal pain 1
• Check inflammatory markers:
  • C-reactive protein (CRP) - correlates with clinical severity in extensive colitis 1
  • Fecal calprotectin (>150 μg/g indicates active inflammation) 1, 5
  • Fecal lactoferrin (>7.25 μg/g indicates inflammatory etiology) 1, 5

Step 2: Rule Out Primary Cardiac Pathology

• Obtain ECG to assess for ischemic changes
• Consider echocardiography if symptoms or ECG changes suggest myocarditis/pericarditis
• Evaluate for other cardiac risk factors

Step 3: Consider Medication-Related Cardiac Effects

• Review medication history, particularly mesalazine which has been associated with myopericarditis 4
• Consider medication-induced cardiac injury if temporal relationship exists between drug initiation and troponin elevation

Step 4: Evaluate for Infectious Complications

• Rule out Clostridioides difficile infection, which can cause pseudomembranous colitis and systemic inflammation 1, 6
• Consider cytomegalovirus colitis, particularly in immunocompromised patients 1

Management Implications

The finding of elevated troponin in colitis should prompt:

1. Cardiac monitoring for patients with severe colitis, particularly those with elevated inflammatory markers
2. Treatment of underlying colitis to reduce systemic inflammation
3. Consideration of medication changes if drug-induced cardiac injury is suspected
4. Cardiology consultation for persistent or significant troponin elevation

Important Caveats

• Troponin elevation in colitis is typically modest compared to acute coronary syndromes
• The degree of troponin elevation may correlate with colitis severity and inflammatory burden
• Patients with known coronary artery disease and colitis are at higher risk for true cardiac events during inflammatory flares
• Normal CRP does not completely exclude active inflammation in colitis, particularly in proctitis 1

In summary, while troponin can be elevated in colitis due to systemic inflammation or medication effects, this finding should not be dismissed as merely a consequence of gastrointestinal inflammation without appropriate cardiac evaluation.