Diagnostic Problem in Acute Myocardial Infarction CK-MB in the Absence of Abnormally Elevated Total Creatine Kinase Levels

Dillon, Michael C.

doi:10.1001/archinte.1982.00340140035009

Cited by 57 publications

(3 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Clinical characteristics and its implications: The absence of an elevation of total CK does not exclude the diagnosis of myocardial infarction, and myocardial necrosis has been documented in one patient with positive CK-MB at autopsy. 10) This study also showed that one of two patients with normal total CK activity and positive CK-MB had histologic changes of scattered necrotic foci. Therefore, discrete histological ischemic changes are not always confirmed in patients with normal total CK activity and positive CK-MB.…”

Section: Discussionsupporting

confidence: 54%

Clinicopathological Characteristics of Left Ventricular Myocardium with Transient Asynergy.

et al. 2001

View full text Add to dashboard Cite

SUMMARYThe aim of the present retrospective study was to clarify the histopathologic substrates of left ventricular myocardium with transient asynergy due to acute ischemic insult in man.Three patients who had had prolonged chest pain, new abnormal Q waves and new ST segment elevation were studied. There was no significant elevation of serum creatine phosphokinase activity in two of the three patients. Echocardiograms on admission or the next day showed severe hypokinetic or akinetic motion and thinning of the anteroseptal and apical portions of the left ventricle and regional dilatation of the same portions. Disappearance of the abnormal Q waves, ST segment elevation resolution, and early T wave inversion were observed later. Complete improvement of the echocardiographic abnormalities was confirmed after a few weeks in all patients.Manifest ischemic lesions of subendocardial scars of the anteroseptal region of the left ventricle were detected in only one of the three cases by gross examination. However, on microscopic examination, islands of necrotic myocytes were interspersed with islands of viable cells throughout the jeopardized region in one case, although the scattered necrotic foci were restricted to the subendocardium and the trabeculae. Normal myocardium and subendocardial scars were observed in the other two cases.In conclusion, left ventricular myocardium with transient asynergy, detected clinically during acute ischemic attack, consists of normal myocardium or small ischemic lesions primarily in the subendocardium. (Jpn Heart J 2001; 42: 235-248)

show abstract

Section: Discussionsupporting

confidence: 54%

Clinicopathological Characteristics of Left Ventricular Myocardium with Transient Asynergy.

et al. 2001

View full text Add to dashboard Cite

show abstract

“…The same authors emphasized the difficulty of differential diagnosis due to symptoms overlapping and the importance of an early diagnosis and treatment: a delay in treatment while awaiting cardiac biomarkers may lead to serious complications [22]. Acute cholecystitis has been often associated with troponinosis [23] and rise in CPK [24]; moreover, some patients experienced retrosternal pain and ST changes on ECG [25] in association with gallbladder disease. Gallbladder disease has been often associated with conduction disturbances, as reported by Franzen et al, who documented the case of 48-year-oldwoman who has suffered from acute cholecystitis followed by two syncopal episodes.…”

Section: Acute Cholecystitis and Cvdmentioning

confidence: 99%

Acute acalculous cholecystitis and cardiovascular disease: a land of confusion

Tana

Cocco

et al. 2015

J Ultrasound

View full text Add to dashboard Cite

Acute acalculous cholecystitis (AAC) can be defined as acute inflammatory disease of the gallbladder without evidence of gallstones. The first case was reported in 1844 by Duncan et al.; however, some cases may have been missed previously in view of the complexity of the diagnosis. Several risk factors have been identified, and cardiovascular disease (CVD), in view of its multiple mechanisms of action, seems to play a key role. Atypical clinical onset, paucity of symptoms, overlap with comorbidities, and lack of robust, controlled trials result often in under or misdiagnosed cases. Moreover, laboratory results may be negative or not specific in the late stage of the disease, when a surgical treatment cannot be longer helpful if complications arise. A rapid diagnosis is therefore essential to achieve a prompt treatment and to avoid further clinical deterioration. In this short review, we would present the current evidence regarding epidemiology, pathophysiology, and clinical presentation of the complex relation between AAC and CVD. Then, we fully emphasize the role of ultrasound to achieve an early diagnosis and an appropriate treatment in suspected cases, reducing mortality and complications rates.Keywords Acute acalculous cholecystitis Á Gallbladder Á Cardiovascular disease Á Ultrasonography Á Emergency Department Á Surgery Riassunto La colecistite acuta alitiasica (AAC) può essere definita come una infiammazione acuta della colecisti in assenza di calcoli. Uno dei primi casi clinici riportati in letteratura risale al 1844 (Duncan et al.) ma verosimilmente alcuni di questi sono passati inosservati a causa della complessitá del percorso diagnostico. Numerosi fattori di rischio sono stati identificati e, tra questi, le malattie cardiovascolari, in considerazione di diversi meccanismi d'azione, sembrano assumere una posizione importante e giocare un ruolo chiave. Molti casi possono passare inosservati per varie ragioni che vanno dall'esordio clinico atipico, la povertá di sintomi, la sovrapposizione clinica e strumentale con altre comorbiditá, la carenza di trial controllati. Inoltre i test di laboratorio possono risultare negativi o non specifici anche negli stadi avanzati della malattia, quando la terapia chirurgica può non rivelarsi più utile in caso di complicanze. Una diagnosi rapida é dunque necessaria per instaurare un trattamento mirato e per evitare un ulteriore deterioramento clinico. In questa breve revisione vogliamo mettere in risalto le evidenze attuali che riguardano l'epidemiologia, la fisiopatologia e la presentazione clinica della complessa relazione esistente tra le malattie cardiovascolari e la colecistite acuta alitiasica. Il nostro intento é dunque quello di enfatizzare il ruolo dell'ultrasonografia nel raggiungimento, nei casi sospetti, di una diagnosi precoce e di un trattamento appropriato, al fine di ridurre il tasso di complicanze e la mortalitá.

show abstract

“…It has been documented that normal total CK levels may mask the diagnosis of MI among patients with elevated CK-MB isoenzyme levels. [24][25][26] On the other h a n d , A E D m e a s u r e m e n t o f t h e C K -M B concentration has been shown to be able to identify AMI in low-risk patients in whom the diagnosis would otherwise have been missed. 27,28 Other studies have also shown that CK-MB measurements performed on presentation at the Emergency departments and at 2 hours were predictive of 'potentially life-threatening cardiovascular complications'.…”

Section: The Ck-mbmentioning

confidence: 99%

Patient with Chest Pain of Obscure Origin: Can AMI be Recognised Early at AED? - A Review of Diagnostic Methods and a Suggested Protocol for the Local A&E Department

Man

Cheung²

2000

Hong Kong Journal of Emergency Medicine

View full text Add to dashboard Cite

Chest pain is a common presentation to Accident and Emergency departments (AED). There are many causes ranging from the most trivial, an example of which is costochondritis to the life-threatening examples such as acute myocardial infarction (AMI). It is not uncommon for acute myocardial infarction to present as atypical chest pain or discomfort, or non-diagnostic electrocardiogram (ECG). The various common diagnostic methods for AMI in patients with atypical chest pain are reviewed and a suggested protocol for managing patient with chest pain of obscure origin at AED is presented. The recent introduction of rapid bedside troponin assay is likely to bring a major impact on the management of atypical chest pain in future.

show abstract

Diagnostic Problem in Acute Myocardial Infarction CK-MB in the Absence of Abnormally Elevated Total Creatine Kinase Levels

Cited by 57 publications

References 30 publications

Clinicopathological Characteristics of Left Ventricular Myocardium with Transient Asynergy.

Clinicopathological Characteristics of Left Ventricular Myocardium with Transient Asynergy.

Acute acalculous cholecystitis and cardiovascular disease: a land of confusion

Patient with Chest Pain of Obscure Origin: Can AMI be Recognised Early at AED? - A Review of Diagnostic Methods and a Suggested Protocol for the Local A&E Department

Contact Info

Product

Resources

About