HEART FUNCTION TESTS

John Wendel said:

Dr..Chung 1. What blood test is the best test in diagnosing an
accute myocardial infraction: GOT, LDL, troponin I, CKMB, index, CPK?

The best test is not a blood test. It is an EKG. Next are the troponins.

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2.
What blood test is the best test in diagnosing an accute myocardial
infraction at 12--18 hours(since onset of symptoms)?

Troponins

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3 Would troponin I
< 0.1 ng/ml and troponin I < 0.15 ng/ml mean the same?

Mathematically no.

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4. Does
troponin I measures anything < 0.1 ng/ml,like 0.05 ng/ml, with a
normal limits of 0.00--1.5ng/ml?

Depends on the lab.

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5.Does jogging 60 minutes x 6 days a
week plus inteerval training 2 x a week (fastest running as possible)
increase CKMB from 0.0 to 2.0 or 3.0 ng/ml ,but still within normal
limits of 0.0--6.0 ng/ml?

No.

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If yes why? Thank you

You are welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Chung 1. If the Troponin I result is reported as 0.1 ng/ml with a
normal limits of 0.0--1.5 ng/ml would one have to assume that above
result is anywhere from 0.05 to 0.15 ng/ml or is the above result 0.10
ng/ml? 2. If a person has jogged 60 minutes and plus within this time
has also done interval running (fastest racing) and that after 12 to 18
hours is tested and CKMB blood test is 2.3 ng/ml with normal limits of
0.0--6..0 ng/ml,what would have caused CKMB to increase to 2,3 ng/ml
from 1,0 ng/ml when this same person is jogging 45 minutes,but has not
done interval racing? 3. Does fast running (racing) increase CKMB by at
least 1.5 ng/ml?4.Do skeletal muscle injuries cause CKMB to increase by
1.3 ng/ml to 2,3 ng/ml with normal limits of 0,0--6.00ng/ml? 5. Would
having Troponin I <0.1 ng/ml and CKMB 2.3 ng/ml at 12 to 18 hours since
symptoms started be enough to diagnose an accute myocardial infraction
or more blood tests like GOT ,LDH is needed?Thank you

John Wendel said:

Dr.Chung 1. If the Troponin I result is reported as 0.1 ng/ml with a
normal limits of 0.0--1.5 ng/ml would one have to assume that above
result is anywhere from 0.05 to 0.15 ng/ml or is the above result 0.10
ng/ml?

Should be the latter.

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2. If a person has jogged 60 minutes and plus within this time
has also done interval running (fastest racing) and that after 12 to 18
hours is tested and CKMB blood test is 2.3 ng/ml with normal limits of
0.0--6..0 ng/ml,what would have caused CKMB to increase to 2,3 ng/ml
from 1,0 ng/ml when this same person is jogging 45 minutes,but has not
done interval racing?

Laboratory measurement variance.

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3. Does fast running (racing) increase CKMB by at
least 1.5 ng/ml?

No.

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4.Do skeletal muscle injuries cause CKMB to increase by
1.3 ng/ml to 2,3 ng/ml with normal limits of 0,0--6.00ng/ml?

No.

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5. Would
having Troponin I <0.1 ng/ml and CKMB 2.3 ng/ml at 12 to 18 hours since
symptoms started be enough to diagnose an accute myocardial infraction
or more blood tests like GOT ,LDH is needed?

Neither.

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Thank you

You're welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Chung 1.Your answer to my last number two question was "Laboratory
measurement variance." Would you explain what do you mean by the
Laboratory measurement variance since both CKMB tests were done at the
same lab,but only a year apart? 2. I do know that standard CRP blood
test cannot detect CRP levels <0.30 mg/dl . Is the same true with
Troponin I levels <0.1 ng/ml and <0.15 ng/ml (that is , Troponin I
cannot detect Troponin I levels < 0.1 ng/ml and at some labs <0.15
ng/ml)? 3. If Troponin I cannot detect Troponin I levels <0.1 ng/ml and
at some labs < 0.15 ng/ml than I guess an result reported as <0.15
ng/ml can mean any number from 0.00 to <0.15 ng/ml? 4. What would
average levels of Troponin I and CKMB be in men who do not have heart
disease and who do have CAD? 5. In men who had large and small heart
attacks,how long after heart attacks do Troponin and CKMB stay
elevated,at what levels and would 6 weeks later they still be slightly
elevated,but within normal limits.Thank you

John Wendel said:

Dr.Chung 1.Your answer to my last number two question was "Laboratory
measurement variance." Would you explain what do you mean by the
Laboratory measurement variance since both CKMB tests were done at the
same lab,but only a year apart?

You can use any measuring equipment and do multiple serial measurements of
the same thing/sample and not get exactly the same number. This is ok as
long as the variance in within manufacturer specs.

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2. I do know that standard CRP blood
test cannot detect CRP levels <0.30 mg/dl . Is the same true with
Troponin I levels <0.1 ng/ml and <0.15 ng/ml (that is , Troponin I
cannot detect Troponin I levels < 0.1 ng/ml and at some labs <0.15
ng/ml)?

No.

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3. If Troponin I cannot detect Troponin I levels <0.1 ng/ml and
at some labs < 0.15 ng/ml than I guess an result reported as <0.15
ng/ml can mean any number from 0.00 to <0.15 ng/ml?

Yes.

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4. What would
average levels of Troponin I and CKMB be in men who do not have heart
disease and who do have CAD?

Normal.

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5. In men who had large and small heart
attacks,how long after heart attacks do Troponin and CKMB stay
elevated,at what levels and would 6 weeks later they still be slightly
elevated,but within normal limits.

Shouldn't be elevated at 6 weeks.

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Thank you

You are welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Chung 1. First (a year ago) CKMB was 1.0 ng/ml and the second (this
month) was 2.3 ng/ml thus laboratory measurement variance is 1.3
ng/ml.Would CKMB variance of 1.3 ng/ml at the same lab with normal
limits of 0.0--6.0 ng/ml be within manufacturer specs? 2, Would very
hard exercise (racing) for extended period of time increase CKMB by at
least 0.5 to 1.0 ng/ml? 3.Are there any medically differences between
0.0,0.1 and 0.15ng/ml Troponins and would there be an high probability
that above all three numbers mean the same? 4. Would BNP blood test
with normal limits of 0--100 pg/ml detect anything less than 5.5
ng/ml? 5. Would BNP of <5.0 ng/ml be helpful in diagnosing LVH, CAD,
CHF etc?If yes how?Thank you

John Wendel said:

Dr.Chung 1. First (a year ago) CKMB was 1.0 ng/ml and the second (this
month) was 2.3 ng/ml thus laboratory measurement variance is 1.3
ng/ml.Would CKMB variance of 1.3 ng/ml at the same lab with normal
limits of 0.0--6.0 ng/ml be within manufacturer specs?

Might be.

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2, Would very
hard exercise (racing) for extended period of time increase CKMB by at
least 0.5 to 1.0 ng/ml?

YMMV.

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3.Are there any medically differences between
0.0,0.1 and 0.15ng/ml Troponins and would there be an high probability
that above all three numbers mean the same?

Would have to take all things in consideration.

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4. Would BNP blood test
with normal limits of 0--100 pg/ml detect anything less than 5.5
ng/ml?

Yes.

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5. Would BNP of <5.0 ng/ml be helpful in diagnosing LVH, CAD,
CHF etc?If yes how?Thank you

Possibly for CHF however this diagnosis still remains largely a clinical
one.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Chung 1. First (a year ago) CKMB was 1.0 ng/ml and the second (this
month) was 2.3 ng/ml thus laboratory measurement variance is 1.3 ng/ml.
Would CKMB variance of 1.3 with normal limits of 0.0--6.0 ng/ml be
within manufacturer specs? 2 Would very hard exercise (racing) for
extended period of time increase CKMB by at least 0.5 to 1.0 ng/ml? 3.
Are there any medically differences between 0.0, 0.1 and 0.15 ng/ml
Troponins I results and would there be an high probability that above
all three numbers mean the same? 4. Would BNP blood test with normal
limits of 0--100 pg/ml detect anything less than 5.5 pg/ml? 5. Would
BNP of < 5.0 pg/ml be helpful in diagnosing LVH,CAD,CHF etc?If yes
how?Thank you

Dr.Chung 1.Do you agree with me that CRP (not HS CRP) can not detect
levels <0.30 mg/dl? 2. What would on echo report "There is no evidence
of IHHS or dynamic left ventricular outflow tract obstruction " mean
and what do IHHS letters stand for? 3. "No valvular abnormality. Trivial
mitral regurgitation is normal." How can there be a trivial mitral
regurgitation which is normal? 4. "No evidence of myocardial
ishemia,pericarditis,Dressler's syndrome,or other cardiovascular
abnormality" What would no evidence of myocardial ischemia and
Dressler's syndrome mean and would the above sentence mean that there is
no evidence of old heart attacks? 5. "RESTING ECG; NSR,NONSPECIFIC ST-T
WAVE CHANGES, WNL'' What would nonspecific st-t wave changes wnl
meanThank you

John Wendel said:

Dr.Chung 1.Do you agree with me that CRP (not HS CRP) can not detect
levels <0.30 mg/dl?

Yes

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2. What would on echo report "There is no evidence
of IHHS or dynamic left ventricular outflow tract obstruction " mean
and what do IHHS letters stand for?

Your cardiologist probably meant IHSS.

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3. "No valvular abnormality. Trivial
mitral regurgitation is normal." How can there be a trivial mitral
regurgitation which is normal?

Trace amounts of regurgitation involving the mitral valve are likely
inconsequential.

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4. "No evidence of myocardial
ishemia,pericarditis,Dressler's syndrome,or other cardiovascular
abnormality" What would no evidence of myocardial ischemia and
Dressler's syndrome mean

No evidence means that nothing was seen that would lead to the diagnosis of
either.

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and would the above sentence mean that there is
no evidence of old heart attacks?

Yes.

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5. "RESTING ECG; NSR,NONSPECIFIC ST-T
WAVE CHANGES, WNL'' What would nonspecific st-t wave changes wnl
meanThank you

wnl usually means "within normal limits," however ST-T wave changes (even
non-specific ones) are not normal, imo.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Chung 1. If everthing is normal "No evidence of myocardial
ischemia,pericarditis,,Dressler's syndrome,or other cadiovascular
abnormality" why cardiologist did not tell me that ECG is
abnormal,because of "NONSPECIFIED ST-T WAVE CHANGES,WNL"? 2. Are
"NONSPECIFIED ST-T WAVE CHANGES,WNL" signs of heart injury,like heart
attack,top fitness etc?If not what does it mean?3. What "YMMV"
means?Thank you

John Wendel said:

Dr.Chung 1. If everthing is normal "No evidence of myocardial
ischemia,pericarditis,,Dressler's syndrome,or other cadiovascular
abnormality" why cardiologist did not tell me that ECG is
abnormal,because of "NONSPECIFIED ST-T WAVE CHANGES,WNL"?

Do not know.

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2. Are
"NONSPECIFIED ST-T WAVE CHANGES,WNL" signs of heart injury,like heart
attack,top fitness etc?

May indicate myocardial ischemia.

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If not what does it mean?

See above.

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3. What "YMMV"
means?Thank you

Your mileage may vary.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Chung 1. On the report says no evidence of myocardial ischemia,but
can top fitness cause "NONSPECIFIED ST-T WAVE CHANGES,WNL?" Thank you

[email hidden] (John Wendel) wrote in message news:<[email hidden]>...

Quoted message said:

Dr.Chung 1. On the report says no evidence of myocardial ischemia,but
can top fitness cause "NONSPECIFIED ST-T WAVE CHANGES,WNL?" Thank you

No.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

Dr. Chung 1. The ECG findings is from the resting ECG written on Echo
report.It is not from a stress-echo ,done 10 minutes later and which was
normal and I guess it is not from an ECG tracing that computer prints
out,because on almost all tracings that computer prints out is written
NSR.NORMAL ECG with the eception of 2 to 3 false borderline ECG tracing
and they were found to be normal by an Echo. 1. Do you think if
there is no evidence of myocardial ischemia and if it is not caused by
top fitness that it can most likely represent early repolarization? 2.
Are there any other possible causes other than CAD blockages that can
cause nonspecific st-t wave changes wnl ? 3.Would it be possible to have
on ECG,only st segment elevation,but no other abnormality and never have
had heart attack? 4.What would early repolarization mean,how is it
diagnosed and does it ever go away or stays for life? 5. How would early
repolarization findings be called: normal,abnormal and if abnormal on
scale from 1 to 10 what would it be (in terms of life threatening)Thank
you

John Wendel said:

Dr. Chung 1. The ECG findings is from the resting ECG written on Echo
report.It is not from a stress-echo ,done 10 minutes later and which was
normal and I guess it is not from an ECG tracing that computer prints
out,because on almost all tracings that computer prints out is written
NSR.NORMAL ECG with the eception of 2 to 3 false borderline ECG tracing
and they were found to be normal by an Echo. 1. Do you think if
there is no evidence of myocardial ischemia and if it is not caused by
top fitness that it can most likely represent early repolarization?

Don't know w/o looking at the EKG.

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2.
Are there any other possible causes other than CAD blockages that can
cause nonspecific st-t wave changes wnl ?

Yes.

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3.Would it be possible to have
on ECG,only st segment elevation,but no other abnormality and never have
had heart attack?

Yes.

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4.What would early repolarization mean,how is it
diagnosed and does it ever go away or stays for life?

It is an EKG diagnosis that stays for life.

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5. How would early
repolarization findings be called: normal,abnormal and if abnormal on
scale from 1 to 10 what would it be (in terms of life threatening)

Abnormal but not life threatening.

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Thank
you

You remain welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr.Chng 1. What other possible causes other than CAD blockages,early
repolarization can cause nonspecific st-t wave changes,wnl and can those
changes on an EKG be reversed?If yes how? 2. On a scale from 0 to
10,zero being lowest abnormality and ten highest,what number would early
repolarization abnormality be? 3 What causes early repolirazition,is it
something that person is born with(congenital) and what symptoms it
causes?4. Are there any restrictions: no athletics,not playing
football,basketball,soccer for proffesional teams etc? 5 Does an EKG
computer prints ot on tracing "early repolarization" or diagnosis is
done by cardiologist looking at the tracing?Thank you

[email hidden] (John Wendel) wrote in message news:<[email hidden]>...

Quoted message said:

Dr.Chng 1. What other possible causes other than CAD blockages,early
repolarization can cause nonspecific st-t wave changes,wnl

Pneumonia, PE, pericarditis, hiatal hernia, to name a few.

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and can those
changes on an EKG be reversed?

Yes.

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If yes how?

Depends on cause.

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2. On a scale from 0 to
10,zero being lowest abnormality and ten highest,what number would early
repolarization abnormality be?

Imho, a 1.

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3 What causes early repolirazition,is it
something that person is born with(congenital) and what symptoms it
causes?

Left ventricular hypertrophy can cause it. Typically there are no
symptoms associated with early repolarization.

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4. Are there any restrictions: no athletics,not playing
football,basketball,soccer for proffesional teams etc?

Typically not for isolated early repolarization.

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5 Does an EKG
computer prints ot on tracing "early repolarization" or diagnosis is
done by cardiologist looking at the tracing?

Typically the latter.

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Thank you

You are welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

Dr.Chung 1. Do you mean by isolated early repolarization = normal
variant early repolarization? 2. Would an normal variant early
repolarization diagnosis stop an athletic and generally healthy pilot
from flying an aircraft (termination of employment)? 3. Would an sinus
bradycardia finding on EKG be called abnormal? 4. Would an sinus
bradycardia on EKG be called normal if characterized by an otherwise
normal EKG and the reason for low heart rate top fitness? 5. You said
that LVH can cause ER,but would disappearance of LVH(if it caused ER)
cause also ER to disappear?6. Cardiologist told me during echo exam that
heart thickness is at upper normal limits and EF is between 65% and
70%.Should I stop intervals and decrease amount of exercise in order for
heart thickness to decrease and thus early repoarization to disappear(if
caused by LVH)?Thank you