Cardiac enzymes Tropon C-K

Question

Can anybody tell me, if they have seen there cardiac enzymes results. I sat in the hospital after suffering chest pains and had several lots of blood drawn  over 12 hours. I was told I had elevated enzymes, Troponin  and CK , but was never shown the results. I then had to undergo an angiogram after the ECG was not conclusive. I was then told I was then told i had not had a heart attack. As anyone seen there cardiac marker results and if so, could yo please advise. Three days I was in Hospital and I am questioning was all this required

gyp260 · Answer

Thanks F Wilson. I have sent you a personal e mail message on this, you may understand my predicament.

Many thanks for the help

fwilson · Answer

I have no idea what the pictures show and would not be qualified to read them.  These are all questions you really have to take up with your doctor.

You have a right to your medical records.  The actual reports.  Ask for them again more forcefully if they are important to you.  If that fails, subpoena them.

Best of luck.

gyp260 · Answer

Many thanks again. I have a report which is vague really. The cardiologist said unspecified vessel in the report.. I was given a dvd of the angiogram, it as 13 scenes on it, the first 12 show like a spider effect when the dye is injected. The 13th scene/frame shows nothing and is blocked completely.This scene as a name at the bottom and it reads A.RAO. 30.CAUD.60. Is this classed as a death to the heart muscle, as result of inadequate blood supply.?

I follow your point about labs. I have requested the readings for my blood time and time again. I always get told they were elevated and we don't have the exact readings. I am only trying to find what is considered an MI. Why cant there be a standard reading, why complicate it with different results from different labs. That seems so ridiculous to me, how can something so simple be made so complicated. Many thanks. 

My other question is can the ejection fraction rise again, ??.

All yor comments are welcomed and I tahnk everybody for the help.
Thanks gyp

fwilson · Answer

Since the statement does not have complete words, I do not know what is meant by, "Is the antheroscler in the unspec vessel"  

Sounds like atherosclerosis in an unspecified vessel.  If so, that means a vessel (which they are not naming) has coronary artery disease (some degree of blockage).  This seems unreasonably imprecise for a medical report.  Which vessel and what degree of blockage would be good questions for the doctor.

To answer your questions you are going to have to get a copy of your medical reports/results.  You cannot answer this here online.  CK is an enzyme found in muscle.  Many muscle injuries can cause this to be elevated in the blood.(even an injection into a muscle can cause it).  CK-MB is much more specific for heart muscle injury.  The advantage of the Troponin tests is they are VERY specific and sensitive for heart muscle injury.  As such, it is the gold standard in many places for making the diagnosis of a heart attack (MI), as your insurance company points out.

You asked, "What would the reading be, if it was defiantly an MI?, I would have assumed there is a base number that  as to be exceeded or increase above a normal reading?"

This is true, but the problem is, that number you are looking for is different from lab to lab.  That is why it is important to get YOUR results.  The number for the cutoff of normal is different from lab to lab.

fwilson · Answer

You may want to start your own thread it will get more visibility that way. I am sorry, I have no idea how to advise you accept to say you shold ask the doctor to better define the relative risks.

gyp260 · Answer

I know nothing about hearts and disease. I did read a section in a mag, when i was in Hospital talking about a senior around the age of seventy five having a mitral clip fitted as her Mitral valve was not working correctlty. If my memory serves me right, I think it was done without open heart surgery, but I cant say I am 100% of this, I seem to remember something about mitral valve regurgitation.

Like I say, I know nothing about the heart, but hope yo find the answer and help yo need pami.

PAMI1019 · Answer

My husband has advanced emphysema with dilatory cardiomyopathy, and went into the hospital on March 15. After a week or so, they said he had MRSA in his nairs. Then a week or so later, into the bloodstream it went, with a bang, we almost lost him at one pooint. 

A few days ago, they found endocarditis, and said they need to replace the mitral valve. Our quandary is, should we chance the operation, as he still has fevers from the MRSA, goes up and down. Would he be able to sustain an operation of this magnitude. The doctors put it all in my court, telling me it is risky; but, also risky if I don't. What I need to know is how risky is it??!! 

Could someone please help me with this,as time is definitely of the essence!! Thanking you in advance for all and any help you can give me with this!!

gyp260 · Answer

I follow that , thank-you. Is the antheroscler in the unspec vessel that does not inflate with blood , when the dye was injected during the angiogram a death of a portion of the heart muscle??.

I went to the hospital around 8 hours after I had these severe pains in my back and chest, jaw . I thought is was a trapped nerve to start with as I have a problem with a prolapsed disc and thought is was my nerve being trapped again.It was only when i kept feeling dizzy that I went to the hospital. I had no idea what was up, and never expected to be told is was an MI.  I know the pain was severe, but thought an heart attack would send me unconscious, so I never considered it

My insurance co, say there would have been an elevation in cardiac enzymes, and say the way they decide is by two specific readings the CK and the Troponin.

I know they were high and above normal, well that is what was said at the time I was told I had an MI. I have asked for the results but have been told they were high and that is it. 

What would the reading be, if it was defiantly an MI?, I would have assumed there is a base number that  as to be exceeded or increase above a normal reading??. The other issue that as come up, is some enzyme readings are increased by muscle injury's and that is why they specifically state the Troponin is the main reading that they evaluate off. 

This kind of situation seems unfair, I cant see why I now take all these meds, if I did not suffer an MI. My ramiprill started off a 2.5mg and has been increased 3 times to 10 mg in around 5 months.

Can the Ejection fraction increase again or is a permanent once you have had a MI?  

I apppreciate your knowledge and help F Wilson, many thanks

kenkeith · Answer

Although you didn't state the chemistry of interest, I assumed you are referring to MI markers in the blood stream.  If, within, a very short time after a suspected MI (24 hours?) there will be evidence of cell necrosis in the blood stream.  

The blood test most commonly used to confirm the existence of heart muscle damage is the creatine kinase (KREE'ah-teen KI'nas), or CK for short. A small fraction of the CK enzyme, CK-MB, is often measured as well. CK-MB shows an increase above normal in a person's blood test about six hours after the start of a heart attack. It reaches its peak level in about 18 hours and returns to normal in 24 to 36 hours. The peak level and the return to normal can be delayed in a person who's had a large heart attack, especially if they don't get early and aggressive treatment.

Tests can measure the level of other cardiac muscle proteins called troponins (tro-PO'ninz), specifically troponin T (cTnT) and troponin I (cTnI). These proteins control the interactions between actin and myosin, which contracts or squeezes the heart muscle. Troponins specific to heart muscle have been found, allowing the development of blood tests (assays) that can detect minor heart muscle injury ("microinfarction") not detected by CK-MB.  Normally the level of cTnT and cTnI in the blood is very low. It increases substantially within several hours (on average four to six hours) of muscle damage. It peaks at 10 to 24 hours and can be detected for up to 10 to 14 days.

gyp260 · Answer

Many thanks . I find it all confusing. Perhaps I did not explain myself well. I had ECG , then had a 2 dimensional Doppler and color flow echocardiographic imaging streeS echo, which shown the abnormal baseline echo, with failure of appropriate augmentation of the akinetic and posterior walls. The angiogram  report and was normal apart from 40% stenosis of the RCA , The LAD mildly aneurysmal 40%. CIRC 25% CIRCUMFLEX DISEASE . The images on my disc show one section that does not fill with blood, when the dye is injected and says coronary antheroscler unspec vessel. 

My insurance covers an MI  and they say its not proven without the cardiac enzymes being elevated and a death of a portion of the heart muscle as a result of inadequate blood supply. I assumed the section of my heart that has this antheroscler, is an a result of inadequate blood supply. It would be inappropriate to say what my insurance company say about the hospital , and likewise by them. I feel I'm being conned by someone.My insurance  seem to be suggesting all this was present and noT as a result of the MI. I now take Ramiprill 10mg a day, Asiprin 150mg aday, Rouvastatin 10mg aday, and Toprol 50mgaday.

Any thoughts.

fwilson · Answer

Gotta love when you cannot get straight answers...

"My ECG showed abnormal base line echo..."  I have no idea what this means, but it seems the combination of evidence on the ECG, cardiac enzymes and symptoms, lead you doc to conclude you ahd a heart attack.  This seems like a reasonable working diagnosis if the 2 tests did indeed show evidence.

I assume you had an echo as you mention wall motion abnormalities prior to the angiogram.  The angiogram you state was normal other than again showing wall motion abnormalities and a lower than normal ejection fraction (evidence of current/past injury to the heart) .

A lot of what you said SOUNDS like someone who had a heart attack.  You will need to press to get your actual test results.  Lab references differ from lab to lab and comparing my numbers to your is comparing apples to oranges.

Good luck.

gyp260 · Answer

My ECG showed abnormal base line echo, and the cardiologist said this coupled with the Troponin tests and CK indicated a Infarction.He also said my was heart had wall abnormalies at rest, staing the inferior and posterior mycardial segments are severly hypokinetic at rest.I then had a angiogram, which was normal apart from the LV, which has left venticular systolic function with diaphragmatic and anterolateral wall motion abnormalities and an estimated ejection fraction of 40%. 

I have since attempted to find out the enzyme readings (troponin and CK), as my insurance company question the validity of a MI . Ihave just been repeatedly told the readings were high, 

This is why I ask the question, as anyone else seen theirs, as I have not and this has me wondering, did I suffer an MI or not. What figure of Troponin and CK constitues an MI ??, 
Thanks Gyp

fwilson · Answer

Yes, I have the results for several of my cardiac enzyme reports. I am curious what advice you would like; as whether or not the treatment was appropriate depends on YOUR enzyme reports as opposed to anyone else's.