The patient was a 48-year-old man admitted to the coronary care unit complaining of substernal chest pain. During the 4 months preceding admission, he noted chest pain radiating to his neck and jaw during exercise or emotional upsets. The pain dissipated when he discontinued the activity or relaxed. The results of his physical examination were essentially normal except for a systolic murmur heard best at the apex of the precordium and radiating into the left axilla.
Routine laboratory work
Within normal limits (WNL)
Cardiac enzyme studies
Creatine phosphokinase (CPK), p. 167
235 units/L (normal: 55–170 units/L)
CPK-MB, p. 171
12 ng/mL (normal: 0–3 ng/mL)
Lactic dehydrogenase (LDH), p. 293
120 units/L (normal: 90–200 units/L)
Serum aspartate aminotransferase (AST), p. 107
24 International units/L (normal: 5–40 International units/L)
Troponins, p. 451
Echocardiography, p. 820
Hypokinetic portion of the lateral left ventricle
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