While a 71 year old woman is walking home from a shopping ce

While a 71 year old woman is walking home from a shopping center, she faints and falls. She is driven home by a friend. When home, she realizes that she is bleeding from her mouth and is slightly disoriented. She appears injured from the fall, but she does not remember tripping or falling. The woman is taken to a local emergency department. The examining physician determines that there was a loss of consciousness; to determine the reason, he orders a head CT and ECG and the following laboratory tests: CBC, PT, aPTT, CK, LD, AST, and troponin T and troponin I. All tests are within normal limits. The woman is sutured for the mouth injuries and admitted to a 24-hour observation unit. What possible diagnoses is the physician considering? What laboratory tests would be elevated at 6, 12, and 24 hours if this patient had an AMI? What isoenzyme tests would be useful with this patient?

Solution

The doctor suspects for an acute myocardial infarction, so the troponin T and troponin 1 will be elevated after 6 hours, normally troponin is not found in serum.It\'s presence in blood shows some coronary necrosis, so the increase in troponin level after some interval is an indication of AMI

The doctor also perform Creatine phosphokinase test, since CPK 3 is found in heart only, so it\'s elevation is an indication of heart damage