We had two similar cases: high trop I in patients less than 20 years old. One had a Prinzmetal spasma (confirmed by an ST elevation) and the other one was having Cystic fibrosis.
Ihssan
Dr. Ihssan Bouhtiauy, FCACB, FACB, MBA
>>> Mohammad Al-Jubouri <[log in to unmask]> 07/15 6:57 am >>>
The cardiologist opinion was: acute MI due to non-atherosclerotic causes such as coronary vasospasm, anomalous coronary artery, vasculitis/collagen disease, anti-phospholipid syndrome and other thrombotic disorders.
Autoimmune screen and thrombophilia screen were normal.
Echocardiography was normal.
Angiography was absolutely normal.
Cardiologist's final opinion: MINC (myocardial infarction with angiographiocally normal coronaries) probably due to coronary vasospasm. Such patients has endothelial dysfunction with tendency to increased vasomotor tone and high migraine score.
Our patient did recieve GTN but was not thrombolysed due to initial diagnostic confusion with peri/myocarditis.
The high CRP conincding with presentation and settling down to normal over 3 days together with the cardiac markers, still has no explanation.
regards
Mohammad
Mohammad Al-Jubouri <[log in to unmask]> wrote:
A 19-year-old man (previously fit and well), presented with acute onset stabbing chest pain 24 h prior to admission, not a smoker, no history of recreational drug intake, not febrile, no myalgia/arthralgia, no URT symptoms, no UTI symptoms or gonorrhoea. ECG showed features of pericarditis , echo still has not been performed. The biochemical markers, however, are more in keeping with an acute coronary occlusion:
TnT CKMBmass CK AST LDH
0 h : 1.0 65.2 570 97 683
24 h : 1.6 13.7 162 57 590
The CRP was raised at 151 mg/L and total cholesterol 2.7 mmol/L. The markers temporal rlease pattern is not c/w myocarditis per se.
Summary: a young chap with an acute inflammatory response and acute MI.
The case is yours for comments please.
Mohammad
Dr. M A Al-Jubouri
Consultant Chemical Pathologist
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Dr. M A Al-Jubouri
Consultant Chemical Pathologist
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