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Dear All We measure TnI on the Bayer Immuno 1, one of the bset TnI methods but has recently came across some false positive results. Because of this and the young age of the patient, I decided to measure all the biochemical markers available in our lab., some thing we don't routinely do. The base line sample showed all markers to be within normal while the 12h sample showed a rise of all markers (cardiac specific and non-specific), all results double checked. The rise of these markers within this short time period is characteristic of myocardial damage, not pure skeletal muscle damage and the rise in the gold standard markers (TnI & TnT) confirmed this. There might have been concomitant skeletal muscle release of CK and AST that accentuated the rise in classical enzymes but TnI and TnT have certaily quantified some myocardial damage. TnI on day 2 sample was still elevated at 0.3 ug/L and was < 0.1 ug/L on day 4 sample. The patient is now scheduled for coronary angiography, if this showed patent coronaries, this still would not exclude the fact that a myocardial damge was sustained and coronary spasm might heve been the underlying aetiology of this event. Thanks to all who debated this case. Mohammad --- Ian Barlow <[log in to unmask]> wrote: > Dear all, > I have concerns about this case. > We don't measure AST or CKMB and therefore don't > have the benefit of ratios. > However we do routinely measure total CK and > Troponin I (Bayer Immuno-1). > Using these data alone, my interpretation would be > that this man has > experienced an ACS or am I missing something? If > others disagree, do we all > need to re-launch our AST and CKMB assays? > Look forward to hearing others views. > Ian Barlow > Scunthorpe > UK > > -----Original Message----- > > From: Greg Watts [SMTP:[log in to unmask]] > > Sent: Thursday, June 27, 2002 12:52 AM > > To: [log in to unmask] > > Subject: Re: A case for your thoughts > > > > Looking at the CKMB:CK ratio this case does not > suggest MI to me. Perhaps > > a > > muscle source of the elevated enzymes is more > likely. ? ischaemia or > > something? Neither Troponin result is really > convincing either. > > > > Greg Watts > > Senior Biochemist > > Sydney Adventist Hospital > > [log in to unmask] > > > _______________________________________________________________ > > > > -----Original Message----- > > From: Mohammad Al-Jubouri > [mailto:[log in to unmask]] > > Sent: Wednesday, 26 June 2002 20:52 > > To: [log in to unmask] > > Subject: A case for your thoughts > > > > > > Dear All > > > > A 33-year-old man presented with chest pain of few > > hours duration. The following biochemical markers > were > > performed on admission sample and 12 h later: > > > > Sample 1 Sample 2 > > > > CK 158 1896 > > AST 33 92 > > CKMB mass 2.3 14.9 > > TnI <0.1 1.8 > > TnT <0.1 0.2 > > ECG: non-specific changes. > > Cardiologist impression: subendocardial infarction > > > > > > CAUTION: This message may contain both > confidential and privileged > > information intended only for the addressee named > above. If you are not > > the > > intended recipient you are hereby notified that > any dissemination, > > distribution or reproduction of this message is > prohibited. If you have > > received this message in error please notify the > sender immediately, then > > destroy the original message. Any views expressed > in this message are > > solely those of the individual sender, except > where the sender is > > specifically authorised by Sydney Adventist > Hospital to state that they > > are > > the views of Sydney Adventist Hospital. > > > > ------ACB discussion List Information-------- > > This is an open discussion list for the academic > and clinical > > community working in clinical biochemistry. > > Please note, archived messages are public and can > be viewed > > via the internet. Views expressed are those of the > individual and > > they are responsible for all message content. > > > > ACB Web Site > > http://www.acb.org.uk > > List Archives > > > http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html > > List Instructions (How to leave etc.) > > http://www.jiscmail.ac.uk/ > > ------ACB discussion List Information-------- > This is an open discussion list for the academic and > clinical > community working in clinical biochemistry. > Please note, archived messages are public and can be > viewed > via the internet. Views expressed are those of the > individual and > they are responsible for all message content. > > ACB Web Site > http://www.acb.org.uk > List Archives > http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html > List Instructions (How to leave etc.) > http://www.jiscmail.ac.uk/ ===== Dr. M A Al-Jubouri Consultant Chemical Pathologist __________________________________________________ Do You Yahoo!? Everything you'll ever need on one web page from News and Sport to Email and Music Charts http://uk.my.yahoo.com ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/