http://crim.sciedupress.com Case Reports in Internal Medicine, 2015, Vol. 2, No. 3 ISSN 2332-7243 E-ISSN 2332-7251 22 CASE REPORTS Elevation of troponin T in mechanical ventilated patient with amyotrophic lateral sclerosis A. Graziani 1 , E. Del Giudice 2 , M. Casmiro 3 , G. Pontone 2 , A. Lanzi 1 , F. Mirici Cappa 1 , G. F. Stefanini 1 , Pierpaolo Casalini 4 , Flavia Tani 5 1. Medicina Interna, Ospedale Infermi, Faenza, Italy. 2. Medicina Nucleare, Ospedale Infermi, Faenza, Italy. 3. Neurologia, Ospedale Infermi, Faenza, Italy. 4. Terapia Intensiva, Ospedale Infermi, Faenza, Italy. 5. Cardiologia, Ospedale Infermi, Faenza, Italy Correspondence: Alessandro Graziani. Address: Medicina Interna, Ospedale Infermi Viale Stradone 09, 48018 Faenza, Italy. Email: alessandro.graziani@ausl.romagna.it Received: January 25, 2015 Accepted: April 15, 2015 Online Published: May 25, 2015 DOI : 10.5430/crim.v2n3p22 URL: http://dx.doi.org/10.5430/crim.v2n3p22 Abstract Troponin T is a specific structural protein to the heart and its detection in blood is determined by cardiomyocyte damage. It has also been reported that some non-cardiac disease can increase the circulating level of troponin T. Here we reported a case of Amyotrophic Lateral Sclerosis (ALS) patient with acute thoracic pain and a longstanding increase of troponin t blood levels. Keywords Amyotrophic lateral sclerosis, Mechanical ventilation, Troponin T, Thoracic pain 1 Background Amyotrophic Lateral Sclerosis (ALS) is a selected degeneration of somatic motor neurons, extending from upper motor cortical pyramidal neurons to lower motor neurons of the brainstem and spinal cord that lead to a non-inflammatory muscle degeneration [1] . It usually progresses toward a complete disability with a high mortality rate: only 20% of patients survive more than five years, but ten percent survive more than ten years. Awaji criteria, a composite clinical- electrophysiologic evaluation, has been recently adopted for the diagnosis of the disease [2] . During the course of the disease, patients have a progressive respiratory failure and non-invasive mechanical ventilation represent the first step of the respiratory therapy. In an advanced stage patients need a definitive tracheal tube to protect the airways from fluid inhalation [3] . Nevertheless respiratory failure remains the main cause of death. Some authors described elevated plasma levels of cardiac troponin (cTn) in ALS patients with chest pain that could determine a wrong diagnosis of Acute Coronary Syndrome (ACS). The cause of this phenomenon it’s not well understood, but in some cases it could be due to a secondary hypoxic damage of myocardium in patients with advanced disease. 2 Case report A 65-year-old male with limb-onset alS, and invasive mechanical ventilation, was referred to our hospital due to acute chest pain. Past medical history was significant for Inferior Acute Miocardial Infarction (AMI) on this occasion he