Profiles of Total CK, CK-MB and Troponin I in Acute Myocardial Infarction (AMI)

CASE 2

PATIENT'S HISTORY:

The second patient was a 60-year-old female with poorly controlled non-insulin dependent diabetes mellitus (NIDDM) who was admitted for evaluation of suprapubic pain and nausea. For the previous couple of months she had complained of intermittent nausea and epigastric pressure associated with exercise. These symptoms were relieved by rest. She did not have any previous cardiac or other significant medical history. Her diabetes was treated with glipizide, and she did not take any other medications. Family history was strongly positive for cardiovascular disease (sister died of an MI at the age of 23, both parents died in their 60's). There was remote smoking history, and no record of alcohol or illicit drug abuse. Her current complaint was described as substernal discomfort/pressure graded 4/10 at its worst, with occasional spread to her right arm. In the hospital, she became agitated and experienced one such episode. She was clinically stable with moderate epigastric discomfort, but her ECG was consistent with anteroseptal ischemia (table 3). Her first set of cardiac enzymes was negative (table 4), but her subsequent CK/CK-MB levels indicated possible myocardial injury. Patient was transferred to cardiology service, and her medical regimen was readjusted.

ECG FINDINGS:

LABORATORY DATA:

DISCUSSION

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