Question

Home Insert Design * Arial BI U Layout References Mailings 14 A- A A A abe X2 X? A.A. E Review E. S View . aste Case 3: A 63-year-old man, who was a heavy smoker and heavy coffee drinker, was well until a few weeks before admission at which time he noted vice-like chest pain at rest which was aggravated by exertion. He remained at home for 2 weeks and was relatively free of pain. But he then developed severe chest pain requiring hospitalization. There was no ECG or lab evidence of AMI during the first week in the hospital. While in the hospital, he again developed severe substernal non-radiating chest pain. This was felt to be similar to his previous angina attacks, but to be certain serum was renzyme determinations. Later that evening, he was found in bed, pulseless apneic, with no measurable blood pressure and in ventricular fibrillation. He was defibrillated and transferred to the coronary care unit. Episode 7 6h 197 Lab Data Enzyme Total CK % CK-2 Total LD Flipped LD 12h 328 22 280 Yes 0 48h 638 . 9 988 Yes Reference 50U/L 0% 200U/L No 50U/C 140 164 No No 1. What is the likely diagnosis in this patient? Explain how you came to this conclusion from the lab data. 2. What other enzyme, not measured would also show abnormally high levels? What would be the time frame for this enzyme? Page 4 of 4 708 Words English (US)

Answer 1

1. Diagnosis of patient is Acute Myocardial infarction.

Creatinine phosphokinase is 3 types
a) CK-MM derived from skeletal muscle;
b) CK-BB derived from brain and lungs; and
c) CK-MB, mainly from cardiac muscles and insignificant
amount from extracardiac tissue.

A ratio of CK-MB2: CK-MB1 above 1.5 is highly sensitive for the diagnosis of acute MI after 4-6 hours of onset of myocardial ischaemia. CK-MB disappears from blood by 48 hours.So, in above lan tests , thre is decreasing levels of ck with the time.

Lactate dehydrogenase (LDH)

Estimation of ratio of LDH-1: LDH-2 above 1 is reasonably helpful in making a diagnosis. LDH levels begin to rise after 24 hours, reach peak in 3 to 6 days and return to normal in 14 days. In above tests peak levels of ld confirms the diagnosis.

2.Myoglobin and troponin.

myoglobin-it is first cardiac marker that elevates after ami and returns to normal after 24h.

troponin- gradually increase , peak at 24 h and then gradually decrease . They remain elevated for longer duration of time.