Differential Diagnosis for High CPK MB and Troponin without Chest Pain
Single Most Likely Diagnosis
- Myocardial Infarction (MI) without typical chest pain: This is a common condition where the blood flow to the heart is blocked, causing damage to the heart muscle. Some patients, especially women, diabetics, or the elderly, may not experience typical chest pain, making diagnosis challenging.
Other Likely Diagnoses
- Myopericarditis: Inflammation of the heart muscle and the surrounding sac (pericardium) can cause elevated cardiac enzymes without chest pain.
- Cardiac Contusion: Trauma to the chest can cause heart muscle damage, leading to elevated CPK MB and troponin levels, even in the absence of chest pain.
- Severe Pulmonary Embolism: A large pulmonary embolism can cause strain on the right heart, leading to elevated troponin levels.
Do Not Miss Diagnoses
- Aortic Dissection: A tear in the aorta's inner layer can cause severe pain, but some patients may not experience typical pain, and elevated troponin levels can occur due to involvement of the coronary arteries.
- Cardiac Tamponade: Fluid accumulation in the pericardial sac can compress the heart, leading to elevated troponin levels, and patients may not always experience chest pain.
Rare Diagnoses
- Takotsubo Cardiomyopathy: A condition where the heart muscle becomes weakened and unable to function properly, often triggered by extreme emotional or physical stress, can cause elevated troponin levels without chest pain.
- Rhabdomyolysis with Cardiac Involvement: Severe muscle damage can cause elevated CPK MB levels, and in rare cases, can also affect the heart muscle, leading to elevated troponin levels.
- Infiltrative Cardiomyopathies (e.g., Amyloidosis, Sarcoidosis): Rare conditions where abnormal proteins or inflammatory cells infiltrate the heart muscle, causing damage and elevated troponin levels.