Unexplained Elevated CPK Level
Quote:
> >Does anyone on the net know what elevated CPK levels indicate?
> >I first leaned that I had a high CPK level back in September of last
> >year. It was 707. Now it is 1412 (CK-MB 23.1). {*filter*} tests also
> >show a RHEUM factor of 85.9 and a relative index of 2.0 .
> >I have muscle pains and weakness in both legs and cannot walk on my
> >toes. I also now walk with a pronounced gait and am unable to run..
> >I had a muscle biopsy taken from my left thigh in December of last
> >year but it proved to be inconclusive.
> This is not really the area of expertise of most of the members of
> this group, but see if the following is of any value to you.
> CPK (now usually called just CK) is creatine phosphokinase, an
> enzyme present in brain cells, skeletal muscle cells, and heart cells.
> When any of those cells is injured or killed (say, you have a stroke,
> or you have a heart attack, or (anticlimax) you fall on your {*filter*}or
> get an intramuscular injection), some of the CK is released into the
> {*filter*}stream, where it stays for a few hours. There is a certain
> amount of normal leakage, so there is a certain amount of CK in the
> {*filter*} at any time.
> If someone has suspicious chest pain and a suspicious EKG and has a
> much-greater-than-normal CK level in the {*filter*}, then one might be
> inclined to believe that he or she has had a heart attack UNLESS he or
> she had fallen, or had that IM injection, etc.
> About 25 years ago, it was realized that CK comes in three
> varieties, and that with high-tech methods the three can be
> distinguished, although they all do the same work as enzymes. The
> three varieties ("isoenzymes") are called CK-BB (found mainly in
> brain), CK-MM (found mainly in skeletal muscle), and CK-MB (found
> mainly in heart). The word "mainly" is important: For example,
> there's enough CK-MB in skeletal muscle that your CK-MB will rise if
> you fall on your butt, but it won't rise as a fraction of the total CK
> (in fact, it will fall a bit).
> CK-MB comes up in this group because we use it as proof of cardiac
> injury when it is increased AND it is an increased fraction of total
> CK. The actual values that indicate suspicion and proof of heart
> problems will vary from lab to lab, since there are several different
> assays of somewhat different specificity.
> In your case, with your abnormal gait and history of exciting some
> doc's suspicion enough to get a muscle biopsy, I'd bet that all of
> that CK is for some reason coming from skeletal muscle. I doubt that
> you'd get the sort of levels you mention just from the slow muscle
> atrophy that comes with spinal stenosis, but DON'T PAY TOO MUCH
> ATTENTION TO THAT because this is not my field. What it sounds like
> (SAME CAVEAT) is some sort of muscle-specific inflammation, possibly
> in the polymyalgia rheumatica family. Anyway, DON'T LISTEN TO THE
> SPECULATION OF A NONSPECIALIST. If I were you, I'd find a good
> rheumatologist.
> Robert R. Fenichel, M.D.
> (true email address is as above, but without initial NOTQUITE)
Hi Robert, Thank you for posting here. I hope you are a regular
reader and like everyone post when you can. There are a lot of people
who just read and you never know how maney you have helped. I feel bad
about that your time is taken up with the amout of spamming you see on
this ng. If I didnt know that people are putting off seeing an RD and
spending money they might not be able to afford, I would just smile at
the snakeoil. I thank you again for spending your time with us and you
as an md are in very good company as we have some of this worlds best
doctors and medical techs who post here all the time.
Harv
