PakMediNet Discussion Forum : Medicine : young pt. with chest pain.
young pt. with chest pain.a 24yrs old pt.presented with severe chest pain while running two miles marathon.his clinical examination was unremarkable.his ecg was normal.Cardiac enzymes including CPK,AST,and LDH were raised.CPK was progressively rising from day one to day seven,going upto >7000 IU/L.CPK-MB was done on day three.It was 57 U/L(normal <25).Other muscle enzymes were normal.So was the other biochemistry.CXR was normal.ECG remained normal on subsequent days.Echocardiography was also normal.There is no apparent neurological deficit including any sign of proximal or distal weakness.Is physical activity responsible for raised enzymes including CPK-MB.
Posted by: majorirfan Posts: 5 :: 30-01-2003 :: | Reply to this Message
Re: young pt. with chest pain.
The case history is interesting. What about the possibility of Myocarditis?
Experts should reply.
Posted by: docosama Posts: 333 :: 01-02-2003 :: | Reply to this Message
Re: young pt. with chest pain.
Interesting but not unusual, several young marathon runners of both sexes have been reported to have chest pain with elevated cardiac enzymes and no other detectable abnormality (and I emphasize 'detectable').
Currently, I have three young female patients who are long distance runners and seeked my advice because of anovulation. Further exploration of their histories did reveal occasional complaints of chest pain and findings of elevated cardiac enzymes with no other abnormality. The logical explanation, by most experts in the field, is that these people have hypertrophied cardiac muscle which is well oxygenated most of the times, to a certain exercise threshold which may be different for different people, and anytime that threshold is exceeded, coronary blood flow may not be adequate. There may or may not be permanent myocardial injury. Deaths have been reported in several basketball players with similar findings, who ignored the warnings and continued the game even after they felt the chest pain.
Posted by: chameed Posts: 173 :: 02-02-2003 :: | Reply to this Message
Re: Re: young pt. with chest pain.
quote:
docosama wrote:
The case history is interesting. What about the possibility of Myocarditis?
Experts should reply.
Posted by: majorirfan Posts: 5 :: 02-02-2003 :: | Reply to this Message
Re: Re: young pt. with chest pain.
quote:
chameed wrote:
Interesting but not unusual, several young marathon runners of both sexes have been reported to have chest pain with elevated cardiac enzymes and no other detectable abnormality (and I emphasize 'detectable').
Currently, I have three young female patients who are long distance runners and seeked my advice because of anovulation. Further exploration of their histories did reveal occasional complaints of chest pain and findings of elevated cardiac enzymes with no other abnormality. The logical explanation, by most experts in the field, is that these people have hypertrophied cardiac muscle which is well oxygenated most of the times, to a certain exercise threshold which may be different for different people, and anytime that threshold is exceeded, coronary blood flow may not be adequate. There may or may not be permanent myocardial injury. Deaths have been reported in several basketball players with similar findings, who ignored the warnings and continued the game even after they felt the chest pain.
Posted by: majorirfan Posts: 5 :: 02-02-2003 :: | Reply to this Message
Re: Re: Re: young pt. with chest pain.
quote:
majorirfan wrote:
[A plausible explanation.But this theory still depends upon possibility of relative ischemia.Although we did CPK-MB on Day 3,it was more than twice the normal.Now there are two possibilities.1).Ongoing ischemia.or 2)It was raised because of initial insult.In case of second possibility,considering the half life,initial rise would have been much higher.It will be very strange to find normal ECG with this high value of CPK-MB.Ongoing ischemia is even more remote chance.
Posted by: chameed Posts: 173 :: 02-02-2003 :: | Reply to this Message