Editor—In their editorial on raised cardiac troponins Ammann et al omit an important cause of increased troponin concentration in obstetric medicine—gestational hypertension and pre-eclampsia.1
Fleming et al showed fivefold higher median values for cardiac troponin I in preeclamptic women than in normotensive pregnant women.2 These median values were above those which would be indicative of significant myocardial damage. Awareness of this becomes important in women with severe pre-eclampsia complicated by pulmonary oedema, the pathogenesis of which is likely to be multifactorial related to capillary leak, hypoalbuminaemia, hypertension, and global left ventricular dysfunction. It is also important as the other commonly used marker of myocardial ischaemia, the MB isoenzyme of creatine kinase, is raised in around a third of normal pregnant women on the first postpartum day after vaginal delivery.3
Competing interests: None declared.
References
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