If I Don’t Have Heart Damage, Why Does My Left Chest Ache?

This week, I got a troponin test.

Troponins are a type of protein only heart cells make. When heart cells die, they leak troponins into the blood, where they persist until kidneys remove them.

Every living heart loses at least a few cells per day, so there’s always at least a trace of troponins in the blood. Only three things can cause troponin levels in the blood to rise: a) running a marathon or an equivalent feat of physical effort (there is so much going on in the muscles that the kidneys temporarily can’t clear troponins, this isn’t a problem) b) something wrong in the kidneys (rare, but it can happen), or c) a ton of heart cells have died.

Mass heart cell death is by far the most common cause of a ‘positive’ troponin test (i.e. higher than normal levels of troponin). Heart attacks always cause troponin levels in the blood to shoot up. Myocarditis also always causes troponin levels to go up. Most heart diseases cause troponin levels to go up. It is the best biomarker to determine whether something is wrong with the heart.

According to The Exquisite Machine by Sian E. Harding, even a slightly-higher-than-normal troponin level is correlated with a much higher rate of heart attacks over the next few years compared to people who test negative for troponins.

My troponin test result: negative.

That’s a relief. It means I don’t have myocarditis after all, nor have I had any heart attacks in the weeks prior to the test, nor do I have most of the other heart diseases.

So what’s going on in my chest?

Pericarditis can have symptoms similar to myocarditis, so similar that it’s sometimes difficult to tell them apart. My chest sensations are consistent with some descriptions of pericarditis. And two-thirds of people with pericarditis test negative for troponins.

Until this started, I had no idea I had an organ called a ‘pericardium.’ It is the sack which holds the heart. It lubricates the heart so it beats smoothly and keeps it in place so it’s not thumping into other organs. Pericarditis is, you guessed it, inflammation of the pericardium. It can sometimes cause heart damage, but since I tested negative for troponin, that hasn’t happened to me—yet. That is a reason (among other good reasons, such as stopping aches in my left chest) to make pericarditis go away as soon as possible.

The treatment for mild pericarditis is like the treatment for mild myocarditis: rest, NSAIDs, stop viral infections. People with pericarditis should keep their pulse below 100/minute, which means no vigorous exercise. Slow walks seem to be okay, and I’m now walking more (while keeping a slow pace).

Most cases of mild pericarditis go away within weeks… or months. Yeah, I’ve already had this for about two months. So much for going away in weeks.

Is it something other than pericarditis? Perhaps. That is why ideally I would want a physical cardiological exam—but I trust the medical system with covid and influenza safety even less than I did last month. When I passed by a medical center the other day, I took a peek. A few people indoors with badges—I assume they were employees—who were unmasked. The only masked people I saw inside had no badges, so I assume they were patients or visitors. It’s one thing to get second-hand reports about healthcare workers refusing to wear masks indoors, and another to see it.

By the way, this isn’t allowed in California: all staff in “healthcare settings” are required to wear masks. But what can I do if a doctor or nurse insists on violating state public health orders? Furthermore, the public health order only requires masking, not the use of respirators.

Can I trust doctors and nurses who openly violate public health orders with my health? (Well, yes, if the public health order is bad, but this one is justified, in fact it doesn’t go far enough).

At the blood draw location, the worker wore a surgical mask, which IMO is not enough, but it only took a few minutes, I wore an N95, and a HEPA filter was running, so I felt okay about it.

Doctors prescribe more extreme treatments to people with pericarditis who don’t improve with aspirin or ibuprofen, or who can’t take aspirin/ibuprofen, or who have complications. However, given my mild symptoms and negative troponin test, I would be shocked if they recommended anything other than aspirin-or-ibuprofen, and rest right now (assuming the diagnosis is pericarditis).

So, I will take ibuprofen at the recommended doses for pericarditis. I’ve taken ibuprofen before, so I know I’m not allergic, and the recommended dosage is low risk.

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