OpenHealth Q&A

Seeking Insights on Unexplained Blood Test Anomalies

Hello everyone! I hope you'll forgive the length of my message as I try to condense my situation as much as I can. Some of the information comes straight from my medical records, and I may not always grasp the medical jargon, so feel free to ask for clarification if needed! To give you some background, I am a 22-year-old female, standing at 5'4" and weighing 160 lbs. I'm of Caucasian descent, have mild respiratory issues, and while I don't have other identifiable medical problems, I do cope with significant anxiety — both social and general — along with a persistent mood disorder. It’s worth noting that I was born six weeks premature. Currently, I’m taking 15mg of escitalopram daily. About ten months before a recent visit to the emergency room, I had stopped using cannabis, having previously used it daily. I also vape regularly and had refrained from alcohol for about four months prior, with prior consumption being occasional. For context, I reside in Canada. In August 2021, I sought emergency medical attention due to chest pain, resulting in an admission where I was diagnosed with perimyocarditis. Here are some pivotal results from my initial ER tests: - **Troponin Levels (ng/L)**: Started at 47, and fluctuated during my stay: 48, 46, 56, 48, 53, and 47 upon discharge. (Normal range was previously <15 ng/L, revised to <10 in 2024). - **D-dimer (normal <500 ug/L)**: Started significantly elevated at 3720, with follow-up readings: 3193, 3530, 3677, 3406, and 3149 before discharge. - **ECG Findings**: Showed no remarkable ST elevation or depression, but indicated T wave inversions in leads V1, V2, and 3. Given the alarmingly high d-dimer, the medical team was particularly worried about the possibility of a blood clot. A series of imaging tests — including chest X-ray, CT scan with contrast, heart MRI, and leg ultrasounds — yielded all normal results. Regarding troponin levels, I had just received my second COVID vaccine dose, which some patients reported adverse effects from, yet my timeline did not align closely enough for the team to definitively attribute my symptoms to the vaccine. Regular echocardiograms during my hospitalization revealed minor pericardial effusion (about 5mm), but all other tests returned normal outcomes, confirming no deep vein thrombosis or pulmonary embolism. As they sought explanations for the perimyocarditis, numerous viral tests were conducted, all of which returned negative. Consequently, the medical team speculated that the vaccine could be the culprit. For treatment, I was prescribed colchicine for over six months along with aspirin three times daily to manage discomfort. This is where things become perplexing. Although my heart inflammation treatment progressed, the underlying cause of my elevated d-dimer remained elusive. Notably, my ALT and CK levels have been consistently elevated over recent years, with a family history of thyroid issues prompting me to undergo yearly blood tests. Following this, I was referred to a rheumatologist who ordered an extensive range of tests, including abdominal ultrasounds, liver function panels, autoimmune screenings, complement levels, and others. Everything returned either negative or within normal ranges, with the exception of my ongoing ALT and CK elevations. Here are some historical lab results I’ve accessed: - **ALT (normal <36 u/L)**: 08/21 - 72; 06/22 - 72; 10/22 - 73; 11/22 - 64; 02/23 - 55; 04/23 - 54; 05/25 - 98. - **CK (normal <190 u/L)**: 08/21 - 439; 06/22 - 469. - My AST was measured recently (normal <31 u/L), resulting in 84. After these tests didn’t yield further insights, a gastroenterologist and hematologist were consulted. My experience with the hematologist was disappointing; he barely listened and suggested that I simply ignore the d-dimer anomaly since other results were normal. As someone who values understanding and is apprehensive about the implications of blood clotting, I left feeling frustrated. The gastroenterologist conducted a liver elastography, but again, everything seemed normal. I kept following up with my cardiologist regarding the state of my perimyocarditis, and after several months, I was informed it had healed. However, my troponin levels have remained slightly elevated (in the 30s-40s), despite normal stress echocardiograms indicating no accompanying inflammation. Similarly, my d-dimer consistently measures high, with the last test in June 2022 indicating it was above 5000 (previously at 1717 in March 2022). Acquiring these tests through my family doctor has proven challenging, but my concerns about their abnormal results persist. I recognize that some variations in results may be typical for me, but the significantly elevated d-dimer is especially worrisome, and it's unsettling to have been advised to disregard it. My elevated troponin levels are also alarming since maintaining healthy heart muscle function is crucial. I suggested to my doctors that chronic stress might contribute to the inflammation, but they dismissed this possibility. I continue to experience occasional mild heart discomfort, which dissipates quickly, and I sometimes feel a light pressure on my heart, a sensation I'm unsure was present before. Last February, I went to the ER for severe chest pressure that interfered with my breathing. At that time, my troponin was assessed at 41, later at 42. My cardiologist subsequently recommended another ER visit due to concerns about a possible blood clot. Upon that visit, troponin levels were recorded at 38, and a follow-up CT with contrast and chest X-ray confirmed normal results. They attributed my symptoms to a lung lining infection, advised resting and using over-the-counter pain relievers, and sent me home. My cardiologist then scheduled a stress echo a week later, which showed no signs of inflammation, yet my troponin remained elevated and the d-dimer was recorded at >5000 during the last examination in 2022. I found it arduous to arrange this outpatient test despite having done so previously, and although they checked for pulmonary embolism in the ER, they did not test the d-dimer until I insisted on it. To summarize, I’m left with more questions than answers regarding my condition. If any of you have insights, suggestions, or additional tests to consider based on these details, I would be immensely grateful for your input. Thank you in advance for your assistance! I’m more than willing to share any test results or additional information if that would help clarify my situation! I hope to hear from you soon!

Answers (1)

6/18/2025, 6:31:32 PM

OpenHealth AI

Thank you for sharing your detailed medical history; it’s understandable to feel overwhelmed by such complex health issues. I want to help clarify your situation and offer some supportive guidance regarding your blood test anomalies, particularly focusing on the elevated d-dimer and troponin levels.

Main Points:

1. Elevated D-Dimer: This can indicate various conditions, primarily related to clot formation and breakdown, though high levels can also arise due to inflammation or other factors.
2. Troponin Levels: These may indicate heart muscle stress or damage. Since you've had perimyocarditis and your troponin remains elevated, this is something to continuously monitor.
3. Persistence of Symptoms: Your experiences of heart discomfort and elevated troponin"D-dimer warrant close attention, especially in the context of your overall health and anxiety.

Explanation:

• D-Dimer Levels: Elevated d-dimer levels often raise concerns about clotting conditions like deep vein thrombosis or pulmonary embolism. However, these can also be influenced by inflammation, infection, or even stress. It’s important to consider the full picture, including your ongoing anxiety and mood disorders, which may contribute to your symptoms.
• Troponin Levels: Persistence of elevated troponin, particularly after resolution of inflammation from perimyocarditis, needs attention. Even if other heart function tests are normal, it’s wise to investigate this further, as chronic cardiological stress could affect your overall health.

Next Steps:

1. Monitor Symptoms: Keep a symptom diary noting the frequency, duration, and intensity of any heart discomfort. Include any accompanying symptoms like breathlessness, fatigue, or stress levels.
2. Consult a Specialist Again: Seek a second opinion from a cardiologist who specializes in unexplained troponin elevation or cardiac conditions related to infections. You might ask specifically for a review of your d-dimer results in the context of your past medical history and how it relates to your current health.
3. Evaluate Lifestyle Factors: Since anxiety can exacerbate physical symptoms, consider exploring mindfulness or stress-relief techniques (like yoga or deep-breathing exercises) that may help reduce overall stress and, in turn, improve your symptoms.
4. Routine Health Monitoring: Given your history and consistent lab results, advocacy for routine tests, including liver function tests (due to elevated ALT) and d-dimer levels every few months, can help track changes and patterns in your health.

Take care of yourself both physically and mentally, and don't hesitate to reach out to professionals who can provide the support and clarity you need. If further specifics or results are needed for tailored advice, feel free to share!