The learning point from this case is that "in patients
with skeletal muscle disease who develop concomitant
acute MI (without typical history and ECG changes),
serial measurement of a number of markers with short
half lives may be necessary to pin down the myocardial
event.
regards.
--- "Dr. T.A. Gray" <[log in to unmask]>
wrote: > Dear Colleagues
>
> Thanks to all for the helpful suggestions about this
> case posted a few
> weeks ago. I don't have the final answer but the
> following facts have
> emerged:
>
> The case:
> A 74 year old lady admitted with inanition and bed
> sores. History of
> previous diarrhoeal illness ? GI infection. Rapidly
> became unresponsive
> once admitted and required ventilating on ITU.
> No evidence of MI on ecg.
>
> Working diagnosis:
> Guillain-Barre syndrome or Polymyositis
> (Not typical of either).
>
> Results: (Sorry if they don't tabulate on your
> browser)
>
> Date CK CKMB TroponinT TroponinI
> (Abbott)
> IU/L ug/L ug/L ug/L
> <200 0 -5 <0.1 0 - 0.4
>
>
> 5.8 1323 583 3.58
> 6.8 1178 150 3.46
> 7.8 692 132 2.65
> 8.8 753 78 3.01 1.6
> 9.8 859 0.8
> 10.8 825
> 11.8 666
> 18.8 254
> 22.8 178 (Today)
>
> Electrophysiology:
> Predominantly neuropathic ? atypical axonal guillain
> barre (whatever
> that means).
>
> Muscle biopsy:
> Predominantly neuropathic but some myopathic
> features. No evidence of
> inflammatory myopathy.
>
> Electrocardiograph:
> Originally L-axis deviation, now normal.
>
> Conclusion.
>
> She probably had an MI originally but it may have
> been symptomless due
> to neurological condition. She required
> considerable inotropic support
> on ITU which she should not have needed just due to
> respiratory failure
> from guillain barre, although she was also
> potentially septicaemic from
> pressure sores. However, we dug out some old
> samples. This lady had
> been treated for Paget's disease with pamidronate
> (hence her
> hypocalcaemia). We found two bone alk. phos. stored
> samples from visits
> prior to her pamidronate infusion.
>
> November 99 CK 43 TropT <0.01 CKMBmass 1.2
> May 00 CK 5915 TropT 2.78 CKMBmass 387
>
> So something cardiac also happened in May although
> again she was
> asymptomatic from a cardiac point of view.
>
> We have tested for heterophilic antibodies without
> any evidence of
> interference in either CKMBmass or TropT.
>
> She clearly has had some cardiac damage, although
> the cause of this is
> not clear.
>
> Further comments would be welcome.
>
> Trevor
>
> Dr. T.A. Gray
> Department of Clinical Chemistry
> Northern General Hospital
> Sheffield S5 7AU
>
> 0114 271 4309
=====
Dr. M A Al-Jubouri
Consultant Chemical Pathologist
Whiston Hospital
Prescot
Merseyside L35 5DR
UK
__________________________________________________
Do You Yahoo!?
Yahoo! Mail - Free email you can access from anywhere!
http://mail.yahoo.com/
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|