CASE STUDY 12-1 A 51-year-old, overweight white man visits his family physician
ID: 128941 • Letter: C
Question
CASE STUDY 12-1 A 51-year-old, overweight white man visits his family physician with a symptom of "indigestion" of 5 days duration. He has also had bouts of sweating, malaise, and headache. His blood pressure is 140/105 mm Hg his family history includes a father with diabetes who died at age 62 of AMI secondary to diabetes mellitus An electrocardiogram revealed changes from one per- formed 6 months earlier. The results of the patient's blood work are as follows: CK CK-MB LDH LDH AST 129 U/L 0% 280 U/L Isoenzymes 35 U/L (30-60) (Explanation / Answer
1. ANS: No, diagnosis of AMI cannot be ruled out due to family history of death of a father of AMI secondary to diabetes. The blood work also suggests that there is some damage to the cardiac tissue as the levels are high for every blood work. The results also show deviation of ECG and damage to cardiac tissue.
2. ANS: Cardiac Troponins T and I can be used as an additional marker along with CK-MB which is lower than the normal range in the blood work of the patient. CK-MB is found mainly in myocardial cells but its sensitivity and specificity are not as higher as that of Troponin. So the further investigation should include the blood work for Troponin T and I. A lower range for CK-MB does not signify MI sensitivity. Levels can be from: (M)< or =7.7 ng/mL,and (F) < or =4.3 ng/mL, a range lower than 7.7 ng/ mL is ok, anything higher would indicate heart problems.
Myoglobin can also be used as the marker because it is released soon after the acute myocardial infarction and has high sensitivity, it can be used for the early detection of the acute myocardial infarction.
3. ANS: The patient should be admitted to hospital as soon as possible and should go for a further test for the confirmation of the acute myocardial infarction.
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