a man with heart failure clutches his chest while he works in the garden

Anxiety and Enzymes: Part 1

Editor's note: This is Part 1 of a two-part series. Part 2 is titled 'Anxiety and Enzymes: Part 2'.

Around the middle of July 2020, I started experiencing symptoms I associated with my coronary artery diagnosis in 2010: dizziness, lightheadedness, shortness of breath, internal heat rushes that started at my head and traveled to my feet. With two stents and one heart attack in my history, it didn’t take long for me to decide to contact my cardiologist.

More symptoms and tests

The symptoms were preceded by a persistent cough and some tightness in my chest. My primary care doctor recommended a test, which I had and it came back negative, but the cough persisted, so I began to wonder if there was a connection between the cough, my symptoms, and my CAD.

Since I think of myself as being an active, physically fit senior citizen, I get frustrated when my body starts sending me warnings. I should be grateful. Without the warnings I’m might not even be here now. So I scheduled a FaceTime visit with my doctor, explained my symptoms and she scheduled me for a stress test a few days later. I was experiencing mild anxiety but felt confident I would be ok between Monday and Friday.

Off we went to the ER

On Friday morning, a call came from my cardiologist’s assistant. She told me that their tech was out that day so my stress test had to be postponed. She then told me that my doctor was going on vacation the following week so they wouldn’t be able to see me for two weeks! My mild anxiety moved over into the moderate range.

The next day was hot. I did some yard work, but by mid-afternoon, I hit the wall and my symptoms struck again. I’m fortunate that my local hospital is rated in the top one hundred for cardiac care. I called a friend who happens to be the head nurse of the hospital and asked her if the ER was safe. She said it was “safer than going to the grocery store, get over there. Don’t drive yourself.” When my wife got home from shopping, I said, “Please take me to the ER,” and off we went.

I was right

She had concerns

Our local ER has a beautiful new emergency room. I was treated to the full experience and soon found myself in an isolated room. Swabs were taken (came back negative), blood was drawn and an EKG was administered. After a couple of hours, the emergency room doctor shared her thoughts about the results. Even though she was wearing a mask, I could tell by looking at her eyes that she had concerns.

Gray area

I was right. My bloodwork showed what she called “gray area” levels of troponin and my EKG was abnormal, at least by comparison with previous EKGs I’d had. “So I think the smart thing to do is admit you so we can continue to monitor your situation, take more blood samples, administer an echocardiogram in the morning and have a cardiologist look at the results.”

Better safe than sorry

Since I had initiated this visit, I was willing to accept her recommendation. As she said, “We don’t want you to have the ‘big one’ after we send you home.” I smiled and agreed. Better safe than sorry.


I learned from my heart attack in 2012 that enzymes not normally found in the blood are released into the bloodstream during a heart attack. Troponin is an enzyme, also a protein. According to the American Association for Clinical Chemistry1: “Troponins are a group of proteins found in skeletal and heart (cardiac) muscle fibers that regulate muscular contraction. Troponin tests measure the level of cardiac-specific troponin in the blood to help detect heart injury. Normally, troponin is present in very small to undetectable quantities in the blood. When there is damage to heart muscle cells, troponin is released into the blood. The more damage there is, the greater the concentration in the blood. Primarily, troponin tests are used to help determine if an individual has suffered a heart attack.”

The ER doctor explained that further tests would determine if there was more or less troponin in my blood and that would help determine if an angiogram was immediately necessary to look for additional arterial blockage, or if a stress test was needed to gather more data and then decide about the angiogram.
At 8:00 PM, after three hours in the ER, I was wheeled to my room, looking forward to getting some answers the next morning.

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