Question

Mr. H reports that the sharp pain started about 2 days ago and it has gotten so bad that he cannot lie down. He rates the pain as an 8 on a scale of 1 to 10, and it radiates to his neck and back. It is much worse when he takes a deep breath, but leaning forward seems to help him. He is on lisinopril for his high blood pressure and denies any other health problems. Family history is significant for heart disease and hypertension.

What labs would be helpful in confirming or ruling out a myocardial infarction, and what are the advantages of each?

If Mr. H has acute coronary syndrome, what ECG changes are expected?

Answer 1

The following lab test will be very accurate for ruling out a myocardial infarction

• Cardiac biomarkers :These levels remains increased for a specific period of time after an infarction
  • Cardiac Troponin(Trop T ) remains elevated for a longer period of time after an injury to heart muscle .This itself can be used as a confirmatory test for aMI
  • Creatinine kinase remains elevated for first 24 hours
  • CK -MB level increases in about 4 to 6 days and comes yo normal in about 2 days .so this cannot rule out MI
  • Myoglobin levels are increased during a heart insult
• The other test which can be done simultaneously are BNP to rule out the stress in heart,Electrolyte, lipids,blood glucose
• The diagnostic test like EKG and Echo

The ECG reading of an acute coronary syndrome are

• ST elevation is a sign of injury to heart muscle
• Inverted T waves
• Changes in Q waves
• Juncrional or horizontal ST depression.