You are on triage duty in the emergency department (ED) when a patient presents to the ED with symptoms indicative of a myocardial infarction (MI)
The patient informs you that these symptoms have been occurring over the last 4 to 5 days. Which diagnostic study do you expect the physician to order to diagnosis an MI?
A) Myoglobin levels
B) Creatine kinase (CK) and its isoenzyme CK-MB
C) Troponin T and I
D) Lactic dehydrogenase and its isoenzymes
Ans: C
Feedback: After myocardial injury, elevated serum troponin T and I concentrations can be detected within 3 to 4 hours; they peak in 4 to 24 hours and remain elevated for 1 to 3 weeks. These early and prolonged elevations make very early diagnosis of MI possible and allow for late diagnosis if the patient has delayed seeking treatment. Myoglobin alone is not used to diagnosis an MI, but negative results can be helpful in ruling out an early diagnosis of MI. CK-MB and its isoenzymes are the first levels to increase and will not be beneficial for a patient who has delayed seeking evaluation and treatment. Lactic dehydrogenase and its isoenzymes may also be analyzed, but these values peak in 2 to 3 days and, again, are not the best diagnostics for a patient who has been experiencing symptoms for 4 to 5 days.
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