I
>-----Original Message-----
>From: Eric Kilpatrick [mailto:[log in to unmask]]
>Sent: 31 January 2002 14:26
>To: [log in to unmask]
>Subject: Cardiac marker panel
>
>
>We are coming under increasing pressure to offer CK in addition to troponin
>T in assessing all types of chest pain. At a recent meeting in Blackpool our
>cardiologists felt exposed that they were the only hospital who did TnTs
>without also CKs. We recommend only using TnT unless it is a barn door
>infarct and a CK is wanted to assess infarct size (we also make exceptions
>for other conditions like renal failure).
>
>Were our heart docs correct in saying most other labs also routinely measure
>CK in addition troponin or is there largely a 'troponin only' policy
>elsewhere?
CK is an important (?essential) part of the investigation of pain which
may be muscular in origin which includes chest pain. Troponin T or I
localise it to the heart and provide prognostic information, but a lot
of chest pains are fairly vague. I continue to add CK to requests for
Troponin where the clinical details suggest a poorly localised pain esp.
if TropT is negative. This was informed by a case where the medical
team treating a man for an MI on the basis of a raised CKMB (in the days
before Troponins) were puzzled by his developing renal failure until his
rhabdomyolysis became clinically evident and it was too late. I have
also seen upper abdo pains due to mesenteric infarction misdiagnosed as
an MI where total CK, when eventually measured, was diagnostic, being
greatly in excess of usual MI levels.
As usual it should not be chest pain = troponin but proper history and
examination followed by targeted investigation - but then that rather
old fashioned view flies in the face of current protocol-driven
treatment.
Trevor
--
Trevor Gray
Dept. of Clinical Chemistry,
Northern General Hospital,
Sheffield S5 7AU
0114 271 4309
|