Psoriasis Lesions mainly affecting the extensor surfaces
There are 3 isoenzymes of creatine kinase (CK)-BB, -MM, and -MB. The primary source of CKMB is myocardium, although it is also found in skeletal muscle. CKMB levels increase with myocardial damage.
Serial quantitation of serum creatine kinase MB (CKMB) levels, often performed at admission and 8-hours, 16-hours, and 24-hours after admission, has traditionally been used as an aid in the diagnosis of myocardial injury
May be useful if the initial troponin determination is abnormal or if a hospitalized patient has a suspected reinfarction
It can also be elevated in cases of carbon monoxide poisoning, crush injuries, pulmonary embolism, hypothyroidism, and muscular dystrophy.
While CKMB has been replaced by troponin assays in the workup of many patients with acute chest pain, CKMB may be useful if the initial troponin determination is abnormal or if a hospitalized patient has a suspected reinfarction.
Males: < or =7.7 ng/mL
Females: < or =4.3 ng/mL
A normal ECG
1. P wave:
upright in leads I, aVF and V3 - V6
normal duration of less than or equal to 0.11 seconds
polarity is positive in leads I, II, aVF and V4 - V6; diphasic in leads V1 and V3; negative in aVR
shape is generally smooth, not notched or peaked
2. PR interval:
Normally between 0.12 and 0.20 seconds.
3. QRS complex:
Duration less than or equal to 0.12 seconds, amplitude greater than 0.5 mV in at least one standard lead, and greater than 1.0 mV in at least one precordial lead. Upper limit of normal amplitude is 2.5 - 3.0 mV.
small septal Q waves in I, aVL, V5 and V6 (duration less than or equal to 0.04 seconds; amplitude less than 1/3 of the amplitude of the R wave in the same lead).
represented by a positive deflection with a large, upright R in leads I, II, V4 - V6 and a negative deflection with a large, deep S in aVR, V1 and V2
in general, proceeding from V1 to V6, the R waves get taller while the S waves get smaller. At V3 or V4, these waves are usually equal. This is called the transitional zone.
4. ST segment:
isoelectric, slanting upwards to the T wave in the normal ECG
can be slightly elevated (up to 2.0 mm in some precordial leads)
never normally depressed greater than 0.5 mm in any lead
5. T wave:
T wave deflection should be in the same direction as the QRS complex in at least 5 of the 6 limb leads
normally rounded and asymmetrical, with a more gradual ascent than descent
should be upright in leads V2 - V6, inverted in aVR
amplitude of at least 0.2 mV in leads V3 and V4 and at least 0.1 mV in leads V5 and V6
isolated T wave inversion in an asymptomatic adult is generally a normal variant
6. QT interval:
Durations normally less than or equal to 0.40 seconds for males and 0.44 seconds for females.