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interpreting CK/CKMB/index

Discussion in 'Emergency Medicine' started by Eidee, Apr 18, 2007.

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  1. Eidee

    Eidee Junior Member

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    So i had a nonverbal pt last night in with a chf exacerbation. EKG essentially unchanged. CKMB significantly elevated at 16 (normal = 5) CK slightly elevated at 324, index elevated at 45 ( normal = 25) however troponins were only 0.11 ( upper limit of normal being 0.5). I talked to the cards fellow and he seemed less than excited

    I thought an elevated CKMB and elevated index like this patient had, would be pretty specific of cardiac damage, and thus would make him a ccu player but cards was fine putting him in tele.

    how should we interpret the ck/ckmb and index when trroponins are within the normal range but nondiagnostic?
  2. NinerNiner999

    NinerNiner999 Senior Member

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    A Ck/ckmb fraction greater than 5% is concerning for myocardial injury, but still "non-specific" in the setting of other more specific marker elevations, such as Troponin I. Remember that there are several different causes for elevated troponins, including myocardial stretch (atrial heart cells stretch in high fluid load states such as CHF and the troponin can "leak" out), renal failure, sepsis, myocarditis, PE, CVA, and other high-volume states. In this case, the ckmb fraction is below 5%, and there is small troponin "leak" consistent with a CHF exacerbation. If this were an NSTEMI, both the index and the actual troponin value would be higher (greater than .5).

    Crit Care Med. 2007 Feb;35(2):584-8.

    Int J Cardiol. 2006 Aug 28;111(3):442-9. Epub 2005 Nov 10.
  3. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

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    This is a good question. Niner notes that a low CKMB index with a slightly elevated troponin (the "troponin leak") is reassuring. But do the older markers like myoglobin and CK really have a role anymore in the age of troponins?
  4. WilcoWorld

    WilcoWorld Senior Member

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    CK/CK-MB rises with a slightly greater rate than troponin I. So, very early after injury one may have a normal troponin, but a positive CK-MB. Of course, at the next blood draw, they should both be positive if the etiology is true myocardial damage.
  5. SolidGold

    SolidGold Florida winters are the best!

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    A little off topic, but why was the patient nonverbal? Too much pulmonary edema and dyspnea? Or just a person without the ability to speak? Makes me wonder why cards was ok with tele and not the CCU.
  6. Eidee

    Eidee Junior Member

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    the guy was non verbal b/c of some rare organic brain disorder (MELAS syndrome).

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