Differential Diagnosis for Elevated CK Total and Troponin I
The patient's laboratory results show elevated CK total and troponin I quantitative, but normal troponin I quantitative and CK-MB. Here's a differential diagnosis organized into categories:
- Single Most Likely Diagnosis
- Myocardial infarction (MI) with skeletal muscle injury: The elevated CK total suggests skeletal muscle damage, while the elevated troponin I indicates myocardial injury. However, the normal CK-MB and troponin I quantitative (on repeat testing) may suggest a small or resolving MI with concurrent skeletal muscle injury.
- Other Likely Diagnoses
- Skeletal muscle injury with minor cardiac involvement: The elevated CK total could be due to skeletal muscle damage from trauma, exercise, or other causes, with a minor cardiac component causing the troponin I elevation.
- Pericarditis or myocarditis: Inflammation of the pericardium or myocardium can cause elevated troponin I and CK total, even if CK-MB is normal.
- Do Not Miss Diagnoses
- Pulmonary embolism (PE) with cardiac strain: A PE can cause cardiac strain, leading to troponin I elevation, and may also cause skeletal muscle injury due to hypoxia or other mechanisms.
- Aortic dissection: This life-threatening condition can cause cardiac and skeletal muscle injury, leading to elevated troponin I and CK total.
- Rare Diagnoses
- Rhabdomyolysis with cardiac involvement: Severe skeletal muscle damage can cause elevated CK total and troponin I, although this is a less common cause of troponin I elevation.
- Cardiac sarcoidosis or other infiltrative diseases: These rare conditions can cause cardiac injury and elevated troponin I, although they are less likely to cause significant skeletal muscle damage.