A 51yearold overweight white man visits his family physician

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 performed 6 months earlier. The results of the patient\'s blood work are as follows: Can a diagnosis of AMI be ruled out in this patient? What further cardiac markers should be run on this patient? Should this patient be admitted to the hospital?

Solution

1. The chances of AMI can\'t be ruled out as the patient has a family history of a death by 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.

2. 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 much high as that of Troponin. So the further investigation should include the blood work for Troponin T and I. 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. 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.