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Q. CK with abnormal ECG findings. What to do?

Answered by
Dr. Yermal Tanmai Deelip
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on May 02, 2021

Hello doctor,

I have been experiencing chest pain. Symptoms first started four days ago, after which I went to the local ER, and an ECG was taken, which came back as abnormal. The ECG findings were - Sinus rhythm normal, atrial premature complexes, probable left atrial enlargement, anteroseptal infarct. I had a thyroidectomy seven years back, so I am on tablet Synthroid. Blood work was also done, which showed higher TSH.values. Everything else was in range, except CK, which was 562 U/L. The ER doctor explained how PACs work and that they are fairly normal; however, I did not see the ECG report and blood work until I was discharged. I booked a Holter monitor and follow-up with a cardiologist. Please provide a second opinion on these results, specifically about the elevated CK count and ECG findings other than PACs. Thank you.

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#

Hello,

Welcome to icliniq.com.

I went throught your query and your ECG (electrocardiograph) (attachment removed to protect patient's identity). Before I could say my opinion, I would like to know some more details about your present symtoms. What is the exact location of your chest pain? Is it continuous or intermittent? Is it at rest or on exertion? What is the nature of your chest pain- is it squeezing type, heaviness, pin prick type, dull aching kind or burning type? Do you have any other cardiac symtoms associated with it like breathlessness on exertion or palpitations, giddiness? Do you smoke or drink alcohol?

Do you have any history of diabetes and hypertension? Do not depend on the printed diagnosis of the ECG. Your ECG is almost normal except for few ectopics or premature complexes. If your chest pain is significant then you need to undergo few tests to rule out any cardiac disease. Kindly get back with above details for further discussion and management strategy. Take care.

Thank you doctor,

The exact location of my chest pain feels like the upper left of the heart. It feels continuous, heavy, and at times it feels more painful. The cardiac symptoms are not that consistent other than palpitations, but I do feel extremely tired. I do not smoke or drink alcohol or have a history of diabetes or hypertension. I am taking capsule Gabapentin for a pinched nerve or bone spur in the cervical spine area. I also had a complete thyroidectomy seven years ago due to papillary carcinoma. My tablet Synthroid is to be adjusted today by my family doctor as per conversation. Can you please tell me the significance of the CK reading?

#

Hi,

Welcome back to icliniq.com.

CK (creatine kinase) is an enzyme that can be released in the body due to various reasons like cardiac events, muscle injury, sepsis, multi-organ dysfunction, etc. As it is a non-specific marker, for cardiac injury specifically, we use the marker- CK MB (creatine kinase-myocardial band) or a more specific one, Trop I (troponin I).

Your chest pain, as per your description, does not seem to be cardiac in origin. Don't worry, but we will respect it and evaluate it further since you have pain and palpitations. Get one 2D Echo (2D-echocardiography) done for your heart and TMT (treadmill test) to ensure you do not have structural heart disease and inducible ischemia.

Since you did not describe your palpitations before, I need to know the following:

  1. How often do you get palpitations?
  2. Do you feel exactly a fast heart rate or forceful heartbeat?
  3. How long does it last every time?
  4. Is it regular beats or irregular beats when you have palpitations?
  5. Also, tell me about your chest pain, whether it increases on pressing over it with the hand?
  6. Is there any history of chest trauma or injury or heavy weight lifting recently?

Stay relaxed, and don't be anxious.

Hello doctor,

Thank you for your insight.

I will have an echocardiogram soon. My palpitations are constant throughout the day. I monitor my heartbeat, and it fluctuates between 80 to 110 BPM over a one-minute sample. I do have a mobile ECG monitor, and it mostly shows regular beats, shows irregular beats as well sometimes. I guess it feels forceful with fast. Today, on my way to work, I had to run to catch a bus for not more than 20 seconds, which typically is nothing for me as I was previously accustomed to running 5 km per day within the last one to two years. I was out of breath and could feel my heart beating out of my chest for 15 to 20 minutes after I caught the bus. I definitely see a change in how my body is responding to activity. Chest pain does not increase by applying pressure with my hand. I have no history of chest trauma injury or heavy weight lifting. I have a bad headache on and off throughout the day, but not sure if there is any correlation with heart activity. I could not sleep last night because of the headache and had to take tablet Ibuprofen for relief, and it returned today and persisted most of the day.

#

Hello,

Welcome back to icliniq.com.

I have noted your history. It suggests that you have significant breathlessness that needs to be evaluated. And the irregular heart beats that you feel are forceful must be the extra beats i.e the premature complexes.

Kindly get your Echo done whenever possible and if that is normal we will proceed further with TMT and 24 hour Holter (ambulatory electrocardiography device) monitoring. If you have gastritis or acidity you can take Tablet Pan 40 mg (Pantoprazole) once in a day for next five days, and tablet Dolo 650 mg (Paracetamol) for headache. Do not do so much exertion till we sort out cardiac issue. Kindly get back with Echo and other reports for further discussion. Take care.

Hello Doctor,

I am currently on a holter monitor (day 2 of 3) and it seemed my rhythm was normalizing over the last few days, however today starting at around 9am EST, after I started working, I experienced tachycardia. The tachycardia persisted for about 9 hours, from 9am to 6pm. Quite honestly, I felt horrible and end up leaving work early. I have a mobile ECG monitor and I took many ECGs throughout the day. I have attached a sample result from almost 3 hours ago (6pm local time). I was wondering if this result suggests ischemia. Please let me know what could be concluded or suspected if anything.

Thank you.
# Hello Ali ,
I saw your Ecg , it is just sinus Tachycardia.
there is no reason to worry about your present ECG.
Anyways good that you have connected your Holter , we will evaluate your entire Rhythm for the duration.
Do you get anxiety or stressed out very often due to work or personal issues?
Also get your Thyroid profile checked (if not checked yet) as imbalance into that report can also lead to palpitations or tachycardia.
Start doing meditation and relaxation exercise and stay calm. Don't get anxious for anything in your routine.
Get back to me once you get your Holter report.
I hope it should be fine.
Take care.

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