Which is the most specific and sensitive test for validating a myocardial infarction?
A. 12-lead EKG
B. Troponin
C. CK-MB
D. CT scan
ANS: B
Diagnostic studies of myocardial infarction include:
• CK-MB—The serum level of CK-MB is elevated above normal in the first few hours after MI and returns to normal within 72 hours. The levels can also be elevated following trauma or with progressive muscular dystrophy.
• Troponin—An inhibitory protein found in muscle fibers, troponin is elevated within 4 hours of an MI and stays elevated for 7 to 10 days. It is more sensitive and specific than creatine kinase for cardiac muscle but may be falsely elevated in patients with kidney dysfunction.
• 12-lead EKG—The practitioner should look for signs of acute ischemia, such as ST-segment elevation or depression, arrhythmias, and conduction delays. An EKG is minimally helpful in diagnosing pericarditis except in the case of cardiac tamponade or constrictive pericarditis where decreased amplitude may be seen.
• Imaging—Studies such as computed tomography (CT) scan, electron beam computed tomography (EBCT) scan, positron emission tomography (PET) scan, magnetic resonance imaging (MRI), and single photon emission computed tomography (SPECT) scan can assist in diagnosing CAD, aortic aneurysms, cardiac masses, myocardial disease, and pericardial disease.
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