A 48-Year-Old Male Presented to the Emergency Department With Chest Pain

A 48-year-old male presented to the Emergency Department with chest pain.  His symptoms began approximately two hours prior to admission and were described as a severe substernal chest pressure with left arm radiation and associated shortness of breath, diaphoresis, and nausea.  Maalox was taken without relief, prompting the ED visit. 

Physical exam: HR 90 BPM, BP 120/85 mmHg, RR 16
The remainder of the physical exam was normal, with no JVD, murmurs, rales, or other evidence of heart failure.

Initial ECG: 3 mm ST elevation in V1-V4 and 2 mm in leads 1 and L.

Initial treatment consisted of aspirin 324 mg, prasugrel 60 mg, 4000U UFH, topical nitrates, and atorvastatin 80 mg.

The patient was taken emergently to the Cath Lab where a 100% LAD occlusion was found which was successfully stented. The ventriculogram showed and EF of 35-40% with severe anterior and apical hypokinesis.

Initial labs were notable for:
BUN/Cr    NL
Hemoglobin    15.5 gm/dL
TnI <0.03 ng/ml
CK-MB of 3.1 ng/ml
CK 110 U/L

Over night the patient did well without further chest pain and no arrhythmias.  Physical exam the next day was essentially unchanged with no evidence of heart failure.

Labs demonstrated:
peak CK 5298 U/L
peak MB 378 ng/ml
peak TnI >50 ng/ml
BUN/Cr remained normal
LFTs: AST 161 U/L (NL up to 50 U/L),  ALT 71 U/L (NL up to 60 U/L), bilirubin 0.6 mg/dl, ALP of 94 U/L
INR and PTT were normal

Based on these results, the increased LFTs likely result from:

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