Question

Patient:

Frank is a 50-year-old white male who works as a foreman in a local auto factory. Frank is a sedentary smoker, and he eats a lot of “fast food” throughout the week during lunch breaks at work. Approximately four hours after shoveling heavy wet snow, he was rushed by ambulance to the emergency department where he presented with substernal chest pain, left arm pain/discomfort, and diaphoresis. Sublingual nitroglycerin and aspirin were administered in the ambulance on the way to the hospital to treat his symptoms. The patient was immediately given morphine on arrival at the hospital. His blood pressure was 180/110 mmHg. An ECG demonstrated ST-segment elevation and tall T waves. Blood was drawn and analyzed for cardiac troponin T (cTnT), cardiac troponin I (cTnI), creatine kinase, and lactate dehydrogenase. These biomarkers were all elevated above resting values. A diagnosis of acute myocardial infarction was made based on these findings. Frank underwent a percutaneous coronary intervention (PCI) with stent placement of his right coronary artery and left coronary artery two hours after arrival at the hospital. He was released from the hospital in stable condition at three days post-MI, and referred to you for out-patient cardiac rehabilitation beginning at two weeks post-MI.

1.   Why did Frank have blood drawn in the emergency department? What are troponin T (cTnT), cardiac troponin I (cTnI), creatine kinase, and lactate dehydrogenase biomarkers of, and why might they be elevated in the blood of a patient with acute MI?             

Answer 1

Mr.Frank blood was withdrawn in emergency department because the typically showed signs and symptoms of myocardial infarction ( sub sternal chest pain,diaphoresis, left arm pain or discomfort, elevated BP,ECG changes- ST elevation and tall T wave)

• Troponin T and Troponin I

This is a protein in the blood. It is released when heart muscle is damaged .More the damage in heart,the greater the Troponin values.The value are high for more than 48 hours after onset of chest pain

• Creatinase kinase (CK) is an enzyme found in the heart tissue. When there is a injury or damage it increases its level in blood
• Lactate dehydrogenase

It is an enzyme almost found in all living cells. This is raised in blood about 24 to 48 hours post myocardial infarction or heart injury.

Hence cardiac markers or bio markers is done to diagnose earlier band start treatment earliest to avoid further complications or problems.