The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?
A. Cancer
B. Hypertension
C. Liver disease
D. Myocardial infarction
Correct Answer: D. Myocardial infarction
Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and peaks within four (4) to six (6) hours after infarction (Remember, less than 90 mg/L is normal). Myoglobin is a heme protein found in skeletal and cardiac muscle that has attracted considerable interest as an early marker of MI. Its low molecular weight accounts for its early release profile: myoglobin typically rises 2-4 hours after onset of infarction, peaks at 6-12 hours, and returns to normal within 24-36 hours.
Option A: Cancer screening is pivotal in reducing the mortality and morbidity from cancer. Some of the screening methods, like a pap smear, have been successful in decreasing the mortality from cervical cancer. In order to maximize the net benefit of screening, it is key to identify the person with an average risk of cancer and subject to screening.
Option B: In hypertension, blood workup includes complete blood count, ESR, creatinine, eGFR, electrolytes, HbA1c, thyroid profile, blood cholesterol levels, and serum uric acid. Ambulatory blood pressure measurement is the most accurate method to diagnose hypertension and also aids in identifying individuals with masked hypertension as well as white coat effect.
Option C: In chronic liver disease, there is inflammation and destruction of hepatocytes that leads to the release of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), hence the high levels of these markers in the blood. Other parameters (ALP and GGT) of LFTs also appear elevated in cholestatic conditions like PBC.
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