In what sequence do fever, leukocytosis, ECG changes, and cardiac markers, such as creatine kinase MB, appear in a patient who has suffered an acute MI? What is the range of fever that can reasonably be linked to MI? What is the expected level of post-MI leukocytosis?
—Antonio B. Martins, MD, Berlin, Md.
ECG changes are usually the first indication of injury, often occurring within minutes. Such changes are confirmed by initial cardiac enzyme abnormalities 1-12 hours later. Fever and leukocytosis follow, reaching a peak in two to four days. Both the fever and leukocytosis are usually low-grade (temperature <101°F and WBCs <15,000/µL).
—Peter F. Cohn, MD (115-7)