MYXEDEMA MIMICKIN MYOCARDIAL ISCHEMI A YOUNG BLACK MALE Sebastian A. Peter, MD Brooklyn, New York
High elevations of creatine kinase secondary to myxedema in a 29-year-old black male resulted in an erroneous diagnosis of mycardial infarction. (J Nati Med Assoc. 1991 ;83:467-468.) Key words * myxedema * elevated creatine kinase
INTRODUCTION High elevations of creatine kinase in hypothyroidism have been reported previously." 2 However, only one of these cases was erroneously diagnosed as a myocardial infarction. The patient was in myxedema coma and, as a result, was unable to give any history to avoid the error in diagnosis. This article reports the case of a patient who presented in the emergency room with retrosternal chest pain and was monitored in the coronary care unit for several days before hypothyroidism was suspected and diagnosed.
CASE REPORT A 29-year-old black male was preparing to take his daughter to the Emergency Room when he developed From the State University of New York Health Science Center, and the Woodhull Medical and Mental Health Center, Brooklyn, New York. Requests for reprints should be addressed to Dr Sebastian A. Peter, 1717 Ditmas Ave, Brooklyn, NY 1 1226. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 5
retrosternal chest pain, sharp in nature. The pain was worse when the patient took a deep breath. The pain did not radiate or worsen on exertion. There was no associated dyspnea or sweating. The patient denied any prior history of chest pain or known cardiac disease, but there was a family history of coronary artery disease. Physical examination was normal except for a pulse rate of 60 beats/minute. An electrocardiogram showed sinus bradycardia with first degree AV block and inversion of T waves in the lateral chest leads. The patient was admitted to the coronary care unit when the initial CPK was found to be 2769 IU/L (normal 0 to 118) using the NAC Activated Procedure (Beckman, California). The creatine kinase-MB (CK-MB) isoenzyme was 10% (normal 0% to 8%) using the Immuno Inhibition Assay (Beckman, California). During the next 48 hours, the total creatine kinase was 2060 and 1464 with CK-MB fraction
High elevations of creatine kinase secondary to myxedema in a 29-year-old black male resulted in an erroneous diagnosis of mycardial infarction. (J Nati Med Assoc. 1991 ;83:467-468.) Key words * myxedema * elevated creatine kinase
INTRODUCTION High elevations of creatine kinase in hypothyroidism have been reported previously." 2 However, only one of these cases was erroneously diagnosed as a myocardial infarction. The patient was in myxedema coma and, as a result, was unable to give any history to avoid the error in diagnosis. This article reports the case of a patient who presented in the emergency room with retrosternal chest pain and was monitored in the coronary care unit for several days before hypothyroidism was suspected and diagnosed.
CASE REPORT A 29-year-old black male was preparing to take his daughter to the Emergency Room when he developed From the State University of New York Health Science Center, and the Woodhull Medical and Mental Health Center, Brooklyn, New York. Requests for reprints should be addressed to Dr Sebastian A. Peter, 1717 Ditmas Ave, Brooklyn, NY 1 1226. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 5
retrosternal chest pain, sharp in nature. The pain was worse when the patient took a deep breath. The pain did not radiate or worsen on exertion. There was no associated dyspnea or sweating. The patient denied any prior history of chest pain or known cardiac disease, but there was a family history of coronary artery disease. Physical examination was normal except for a pulse rate of 60 beats/minute. An electrocardiogram showed sinus bradycardia with first degree AV block and inversion of T waves in the lateral chest leads. The patient was admitted to the coronary care unit when the initial CPK was found to be 2769 IU/L (normal 0 to 118) using the NAC Activated Procedure (Beckman, California). The creatine kinase-MB (CK-MB) isoenzyme was 10% (normal 0% to 8%) using the Immuno Inhibition Assay (Beckman, California). During the next 48 hours, the total creatine kinase was 2060 and 1464 with CK-MB fraction
