MB CK (myocardial band creatine kinase) 10-25 times in first few hours ↑ of MI, returns to normal in 2-4 days, can be to trauma ↑due Troponin (inhibitory protein in muscle fibers), within 4 hours and for ↑ days, more specific to cardiac muscle. Chest x-ray (suspected aortic aneurysm, pneumonia, pneumothorax, pulmonary edema) CBC and ESR (suspected pericarditis) Amylase/lipase (pancreatitis, cholecystitis) Others: CMP (electrolyte imbalance), lipid profile, TSH (hypothyroidism) Testing in ER or hospital may include: ABGs (unless on thrombolytic therapy, suspected pulmonary conditions), D-dimer and spiral 5CT scan (suspected PE), Echocardiogram (aneurysm, pericardial effusion, valvular disease, cardiomyopathy), Stress test (CAD and angina), Endoscopy (gastric), Cardiac catheterization (MI) Differential Diagnosis Causes of Pain Cardiac Noncardiac Ischemic: Gastroesophageal: Coronary artery disease Esophageal perforation (myocardial Esophageal spasm ischemia/infarction) Reflux esophagitis Aortic stenosis Peptic ulcer Prinzmetal’s angina (Variant Cholecystitis angina pectoris, usually 12 -8 Pancreatitis am, due to arterial spasm) Biliary disease Eating disorder Nonischemic: Pulmonary: Dissecting aortic aneurysm Pleuritis Pericarditis Spontaneous pneumothorax Valvular Disease-Aortic Pulmonary embolism stenosis, Mitral valve prolapse Neoplasm Hypertrophic cardiomyopathy Bronchitis Pneumonitis Pulmonary hypertension Asthma Chronic cough Musculoskeletal: Costochondritis/Tietze’s syndrome Xiphoidalgia Rib fracture Myalgia Muscle strain/overuse syndrome Thoracic outlet syndrome
MB CK (myocardial band creatine kinase) ↑ 10-25 times in first few hours of MI, returns to normal in 2-4 days, can be ↑due to trauma Troponin (inhibitory protein in muscle fibers), ↑ within 4 hours and for days, more specific to cardiac muscle. Chest x-ray (suspected aortic aneurysm, pneumonia, pneumothorax, pulmonary edema) CBC and ESR (suspected pericarditis) Amylase/lipase (pancreatitis, cholecystitis) Others: CMP (electrolyte imbalance), lipid profile, TSH (hypothyroidism) Testing in ER or hospital may include: ABGs (unless on thrombolytic therapy, suspected pulmonary conditions), D-dimer and spiral 5CT scan (suspected PE), Echocardiogram (aneurysm, pericardial effusion, valvular disease, cardiomyopathy), Stress test (CAD and angina), Endoscopy (gastric), Cardiac catheterization (MI) Differential Diagnosis Causes of Pain Cardiac Noncardiac Ischemic: Coronary artery disease (myocardial ischemia/infarction) Aortic stenosis Prinzmetal’s angina (Variant angina pectoris, usually 12 -8 am, due to arterial spasm) Gastroesophageal: Esophageal perforation Esophageal spasm Reflux esophagitis Peptic ulcer Cholecystitis Pancreatitis Biliary disease Eating disorder Nonischemic: Dissecting aortic aneurysm Pericarditis Valvular Disease-Aortic stenosis, Mitral valve prolapse Hypertrophic cardiomyopathy Pulmonary: Pleuritis Spontaneous pneumothorax Pulmonary embolism Neoplasm Bronchitis Pneumonitis Pulmonary hypertension Asthma Chronic cough Musculoskeletal: Costochondritis/Tietze’s syndrome Xiphoidalgia Rib fracture Myalgia Muscle strain/overuse syndrome Thoracic outlet syndrome
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