CK with abnormal ECG findings. What to do?

Hello,

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I went throught your query and your electrocardiograph (attachments removed to protect patient's identity). Before I could give 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. Thank you.

Hello,

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Creatine kinase (CK) is an enzyme that can be released in the body for various reasons like cardiac events, muscle injury, sepsis, multi-organ dysfunction and so on. As it is a non-specific marker, for cardiac injury specifically, we use the marker- creatine kinase-myocardial band (CK MB) or a more specific one, Trop I (troponin I). Your chest pain, as per your description, does not seem to be cardiac in origin. You need not worry. We will 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. How often do you get palpitations? Do you feel exactly a fast heart rate or forceful heartbeat? How long does it last every time? Is it regular beats or irregular beats when you have palpitations? Also, tell me about your chest pain, whether it increases on pressing over it with the hand? Is there any history of chest trauma or injury or heavy weight lifting recently? Thank you.

Hello,

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In my opinion, you have significant breathlessness that needs to be evaluated. And the irregular heartbeats that you feel are forceful must be the extra beats that are, the premature complexes. Kindly get your echocardiogram done whenever possible and if that is normal we will proceed further with a Treadmill test (TMT) and a 24 hour Holter monitoring (ambulatory electrocardiography device). If you have gastritis or acidity I suggest you use Tablet Pan 40 mg (Pantoprazole) once a day for the next five days and Tablet Dolo 650 mg (Paracetamol) for headache. Do not practice aby exertion till we sort out your cardiac problem. Kindly get back with an echocardiogram and other reports for further discussion. Thank you.

Hello,

Welcome back to icliniq.com.

Based on your echocardiogram (attachments removed to protect the patient's identity), it is just sinus tachycardia. There is no reason to worry about your present ECG. It is good to know that you are getting the holter test done. We will evaluate your entire rhythm for the duration. Do you get anxious or stressed out very often due to work or personal issues? Also, get your thyroid profile checked, as imbalances in that report can also lead to palpitations or tachycardia. Start doing meditation and relaxation exercises and stay calm. I suggest you not get anxious about anything in your routine. Please get back to me once you get your Holter report. Thank you.