You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information.
What is Earliest reliable enzyme to increase in AMI and explain in detail?
Ans. a (CPK-MB). (Ref. Harrisons, Medicine, 18th/ Chapter 246.)#Earliest enzyme elevated after AMI:hFABP and Myoglobin#Most specific enzyme:Troponin T (returns nomal in 5-14 dys)#Enzyme imp in Reinfarction:CPKMB (returns nomal in 2-3 dys)#Most common cause of death in AMI:VT leading to VF#Post-AMI autoimmune pericarditis (7 dys later):Dressier syndrome#Time after AMI when cardiac muscle is most subjected to rupture: 3-7 dys#Microscopic changes after AMI: - Neutrophils:1-3 dys of AMI - Lymphocytes:4-7 dys of AMI - Grabulation tissue:7-14 dys of AMIDIAGNOSIS OF AMI# In first six hours ECG is gold standard.# Changes include ST elevation (transmural ischemia) and Q waves (transmural infarct)- CPK-MB is test of choice in first 24 hours of AMI- Cardiac troponin I is used within the first 4 hours upto 7-10 days. More specific:- LDH is elevated from 2 to 7 post Ml day. LDH decrease is specific for cardiac muscles.# Radioisotope Thallium-201 scanning is used to distinguish ischemic from non-ischemic myocardium/ to detect reversible ischemia.# Radioactive stannous pyrophosphate is used to distinguish normal from damaged myocardium.# 2D-ECHO is best initial modality for assessment of valvular abnormalities, wall motion & ventricular ejection fraction (i.e. ventricular function).