An 83-year-old man with known severe coronary artery disease, diffuse small vessel disease, and significant stenosis distal to a vein graft from previous CABG surgery was admitted when his physician referred him to the hospital after a routine office visit. His symptoms included 3+ pedal edema, jugular vein distention, and heart sound abnormalities. Significant laboratory data obtained on admission were as follows:

Urea nitrogen (6–24 mg/dL)----------- 53

Creatinine (0.5–1.4 mg/dL)------------ 2.2

Total protein (6.0–8.3 g/dL) -----------5.8

Albumin (3.5–5.3 g/dL)----------------- 3.2

Glucose (60–110 mg/dL) --------------312

Calcium (4.3–5.3 mmol/L)------------- 4.1

Phosphorus (2.5–4.5 mg/dL)---------- 2.4

Total CK (54–186 U/L) -----------------134

CK-MB (0–5 ng/L) -----------------------4

% CK-MB (<6%) -------------------------3

Myoglobin (<70 μg/L)------------------ 62

Troponin T (0–0.1 μg/L) ---------------0.2

Questions

1. Do the symptoms of this patient suggest acute MI?

2. Based on the preceding laboratory data, would this diagnosis be acute MI? Why or why not?

3. Based on the preceding laboratory data, are there other organ system abnormalities present?

4. What are the indicators of these organ system abnormalities?

5. Is there a specific laboratory test that might indicate congestive heart failure in this patient?