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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Chest Pain

On the 10th my husband went to an ER c/o chest pain - an EKG showed nothing and an emzyme was 100+ On the 14th he went to another ER c/o chest pain and the EKG showed a slight something, and the same enzyme level was 575. Turns out he had 100% blockage of the circumflex artery which supplies the back of the heart. That portion does not show well on an EKG. My question is - why didn t the original ER keep him for a few hours and re-test his enzymes to see if they were rising? Isn t 100+ a high level? We were told that there is another enzyme which appears several hours later - which of course was very elevated on the 14th, but was not present on the 10th. This makes me think that we went to the first ER very early (golden hour) and were sent home having been told there was nothing wrong. I am questioning whether the first hospital should have seen a yellow flag or not. Thank You
Mon, 29 Sep 2014
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Internal Medicine Specialist,  's  Response
HI

Thanks for posting your query .

You are absolutely right . In the initial visit only the ER doctor should have kept him for observation and repeated both EKG and Enzymes after few hours.

In my practice if the chest pain is typical then in spite of normal EKG or enzymes I will advise them to repeat Enzymes after 6 hours for 3 times .

There are different kinds of Enzymes . CPK-MB raises first but it take 1-2 hours to elevate . Next to CPK is Troponin I which takes 3-4 hours to raise . You have not mentioned which enzyme they have tested . Kindly let me know .

But bottom line is they should have asked to repeat enzymes at least 6-12 hours later and not till the patient had Chest pain again .

Any clarifications feel free to ask .

Regards.
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Suggest Treatment For Chest Pain

HI Thanks for posting your query . You are absolutely right . In the initial visit only the ER doctor should have kept him for observation and repeated both EKG and Enzymes after few hours. In my practice if the chest pain is typical then in spite of normal EKG or enzymes I will advise them to repeat Enzymes after 6 hours for 3 times . There are different kinds of Enzymes . CPK-MB raises first but it take 1-2 hours to elevate . Next to CPK is Troponin I which takes 3-4 hours to raise . You have not mentioned which enzyme they have tested . Kindly let me know . But bottom line is they should have asked to repeat enzymes at least 6-12 hours later and not till the patient had Chest pain again . Any clarifications feel free to ask . Regards.