Republic of the Philippines

NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

Cabanatuan City, Nueva Ecija

COLLEGE OF NURSING

Assessing Learning

Activity 4

Name: Anjanette Z. De Belen__ Date: 10-22-21

Section: BSN 1-C Score:__________

A 70-year-old man was admitted to the emergency room with a 12-hour history of chest pain.
Serum creatine kinase (CK) activity was measured at admission (day 1) and once daily (see figure
below). On day 2 after admission, he experienced cardiac arrhythmia, which was terminated by
three cycles of electric cardio - conversion, the latter two at maximum energy. [Note: Cardio
conversion is performed by placing two paddles, 12 cm in diameter, in firm contact with the chest
wall and applying a short electric voltage.] Normal cardiac rhythm was reestablished. He had no
recurrence of arrhythmia over the next several days. His chest pain subsided, and he was released
on day 10.

(1) Which one of the following is most consistent with the data presented? Encircle the letter of
your answer.

A. The patient had a myocardial infarction 48 to 64 hours prior to admission.

B. The patient had a myocardial infarction on day 2.

C. The patient had angina prior to admission.

D. The patient had damage to his skeletal muscle on day 2.

E. The data do not permit any conclusion concerning myocardial infarction prior to, or after,
admission to the hospital.

BIOCHEMISTRY
1st Semester A.Y. 2021-2022
 Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija

COLLEGE OF NURSING

(2) Explain the rationale of your chosen answer.

Among the choices, I believe that the option D is the most consistent with the data
presented. At the admission, the elevated MB isozyme was shown in the CK isozyme pattern in the
figure, indicating that Myocardial Infarction was experienced by the patient 12-24 hours prior to
admission. This means that the option A, as well as option B, is excluded because 48-64 hours after
an infarction, the MB isozyme would have returned to normal values. On day 2, the MB isozyme had
decreased 12 hours after the cardio conversions, which can be concluded that there is no further
damage to the heart. In contrast of the decrease of MB isozyme, the MM isozyme of the patient
increased after the three cycles of electric cardio conversions. This indicates muscle injury, most
likely as a result of frequent cardioconversion's convulsive muscle contractions. Early after
cardioversion, serum CK levels rise significantly, indicating that the injured skeletal muscle is
rapidly washed out. MM-CK levels rise dramatically in those who receive high-energy shocks, owing
to the release of modest amounts of the CK-MM isoform from skeletal muscle. The option C is not
consistent because Angina is typically caused by brief spasms in the heart's vasculature and is
unlikely to result in tissue death and an increase in serum creatine kinase, although certain CK-MB
increases can be detected in angina patients, depending on the laboratory methodology used. Then,
the last option E is obviously excluded, too, from the most consistent data.

BIOCHEMISTRY
1st Semester A.Y. 2021-2022