Dear Geoff,
I summarise the question as follows: Does this patient have cardiac damage
(and if so is it myocardial infarction). The cases, other than assay
interference, where TnT may be high but TnI normal are renal failure
(excluded in this patient) and dermatomyositis (White, Clin Chem
2000;46:A82,Abstr 311, and Clin Chem 2001;47:1130-1,letter). The references
do not conclude whether the elevated troponin T may be due to skeletal
sources or to cardiac involvement of the inflammatory process. The elevated
CKMB (what is the total CK?) may also follow prolonged skeletal muscle
injury with re-expression of the MB isoenzyme. The highest I have seen is
MB about 10% of the total CK. In these patients the MB tends to remain as a
constant fraction of the total CK rather than falling off more rapidly as
may be seen after an AMI. Regarding the question of is this AMI, unless a
rise and fall pattern is seen, it is unlikely to be an infarct.
I am sure there may be other possibilities as well.
Regards,
Graham
Graham Jones
Staff Specialist in Chemical Pathology
St Vincent's Hospital, Sydney
Victoria St, Darlinghurst, 2010
NSW, Australia
Ph: (02) 8382-2170 Fax (02) 8382-2489
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