The question of timing is pertinent to your question about the cause of the heart attack, and with this amount of time between the accident and the heart attack, there less potential confusion regarding the cause of the elevation.
The troponin levels (and other markers of heart attacks) are actually measures of damage to the heart. The vast majority of the time that we see an elevation in troponin levels is from a heart attack (the medical term is a myocardial infarction), and particularly if there is a pattern of an initial normal level, then an increase, then a gradual return to normal. However, one of the possible conditions that can also raise the troponin levels is direct trauma to the heart, called a cardiac contusion. A contusion is the medical term for a deep bruise
, and can be applied to almost any tissue, but in the case of a cardiac contusion, it refers to the heart muscle. However, if there had been a cardiac contusion from the accident on Sunday, there would have been elevation of the troponin level long before Wednesday. Therefore, it is unlikely that there is a cardiac contusion that could be confused with a myocardial infarction.
The other aspect of your question is whether the myocardial infarction was caused by the accident or whether there was some amount of underlying disease that was present, and the answer is that both are true. While a cardiac contusion can occur in any person regardless of age or current level of artery disease int he heart, the precipitation of a myocardial infarction typically occurs in a person with pre-existing narrowing in at least one of the arteries to the heart, that then becomes blocked with clot, completely blocking blood flow. Therefore, the usual scenario is that there was a pre-existing narrowing and the sudden blockage was precipitated by the acute condition.
It is impossible to know whether or when any of the underlying heart narrowing may have caused problems. When there are studies done to look for heart disease, such as in autopsy studies of people that die from other causes, we find that many people have narrowings that had not caused any problems, so there is a fair incidence of some degree of narrowings, but it cannot be said whether they would have caused problems without the precipitating event of the accident. Even though his hypertension has been mild, he also has risk factors of being male and older (and perhaps others), and if anyone lives long enough, they will likely develop narrowings in the heart.
I asked about the echocardiogram because the extent of damage of the heart is better measured by the echocardiogram than by the troponin level. Sometimes, the area of poor blood supply can get a return of blood supply relative quickly, which can flush out the troponin from the damaged muscle and cause a higher elevation, but the relatively rapid return of blood flow will limit the extent of damage. If the echocardiogram shows a relatively small area of damage, then the patient will generally do better than if a larger area of damage was seen. When talking to the doctors, you can ask how much damage was seen on the echocardiogram.
The other questions that you should ask are regarding recovery. The usual recovery process after a heart attack involves cardiac rehabilitation, but will obviously be complicated in his case because of the extent of the musculoskeletal injuries. The ability of the person to participate in cardiac rehab, including whether there is any evidence of continued problems with blood supply with increasing activity, are important indicators of long term prognosis. There will also usually be some assessment of whether there is any evidence of ongoing poor blood supply, such as though an exercise stress test, although there are some other tests that can be done in persons that cannot perform that level of exertion. This test is usually done after there has been time for healing of the myocardial infarction, and if there is any evidence of ongoing poor blood supply, there may need to be further evaluation or intervention
, such as angioplasty. At this point, the doctor would not be able to anticipate every possible scenario, but the findings on the echocardiograms, the plan for performing the rehab and the assessment after recovery could be explained.
If you have any further questions or need clarification, please let me know.