cardiac enzyme (1).pptx NURSING GOOD VERY

1. CARDIAC BIOMARKERS

2. BIOMARKERS -DEFINITION A biomarker is a clinical laboratory test which is useful in detecting dysfunction of an organ. Cardiac biomarkers are protein molecules released into the blood stream from damaged heart muscle These biomarkers are used to detect the heart diseases . It has characteristic rise and fall pattern

3. CARDIAC MARKERS TESTED IN i . Any chest pain ii. Unstable angina iii. Suspicious ECG changes iv. History suggestive of myocardial infarction v. Following surgical coronary revascularization vi. Patients with hypotension and dyspnea

4. WHY WE NEED BIOMARKER STUDY IN ACUTE CORONARY SYNDROME ?

5. It’s because; neither the clinical presentation nor the ECG had adequate clinical sensitivity and specificity for detecting MI without the use of biomarkers

6. What biomarkers are good for Detecting myocardial damage whether due to AMI or other cardiac process ??

7. Which Biomarkers? CK-MB Troponin -I/T LD (LDH) Myoglobin AST BNP Others

8. Serial testing of the following cardiac Markers is usually done to guide the prognosis i . Creatine kinase (CKMB) ii. Cardiac troponin I (CTI) and Cardiac troponin T (CTT). iii . Myoglobin iv. Brain Natriuretic Peptide (BNP). It is a reliable marker of ventricular function v. LDH and AST were previously used as markers of myocardial infarction, but no more used in clinical practice .

9. CARDIAC MARKERS Enzymatic: CK LDH AST Nonenzymatic : Myoglobin Cardiac troponin T and I

10. Aspartate transaminase (AST) AST was the first used as a marker of myocardial infarction in olden days,The level is significantly elevated in myocardial infarction Normal Range-8-20U/L

11. LACTATE DEHYDROGENASE Lactate dehydrogenase catalyses the conversion of  pyruvate  to lactate.

12. LDH -ISOFORMS M4 form is seen in skeletal muscles while H4 form is seen in heart. Normally LDH-2 (H3M1) concentration in blood is greater than LDH-1 (H4); but this pattern is reversed in myocardial infarction;

13. LACTATE DEHYDROGENASE LDH levels are also high in Tissue breakdown Hemolysis cancer,  meningitis,  encephalitis, or HIV. Normal value of LDH in serum is 100-200 U/L

14. Creatine kinase (CK/CPK) Creatine kinase (CK/CPK) is an enzyme expressed in a number of tissues. Function : it catalyses the conversion of creatine to phosphocreatine degrading ATP to ADP The CK enzyme consists of two subunits, B (brain type) or M (muscle type), Making three different isoenzymes : CK-MM, CK-BB and CK-MB

15. Creatine kinase (CK/MB) High specificity for cardiac tissue Begins to rise 4-6 hours after onset of infarction Peaks at about 12 hours Returns to baseline at 24-48 hours Can be used to indicate early re-infarction if level normalizes and then increases again Normal serum value for CK is 15-100 U/L for males and 10-80 U/L for females

16. TROPONIN Troponin is a complex of three regulatory proteins that is integral to non-smooth muscle contraction in skeletal as well as cardiac muscle Troponin is attached to the tropomyosin sitting in the groove between actin filaments in muscle tissue three subunits, TnC , TnT , and TnI Troponin -C (calcium ions) Troponin -T ( tropomyosin ) Troponin -I ( actin )

17. Troponins Troponin T and I are not detected in healthy individuals Troponins are seen in skeletal and cardiac muscles, but not in smooth muscles. Significant increase in Troponins reflects myocardial necrosis They are quantitated by ELISA or immuno turbidimetric) reactions .

18. Troponin I ( cTnI ) Troponin I is released into the blood within 4 hours after the onset of symptoms of myocardial ischemia; peaks at 14-24 hours and remains elevated for 3-5 days post-infarction

19. Cardiac Troponin T ( cTnT ) Serum level of Troponin T ( TnT ) increases within 6 hrs of myocardial infarction, peaks at 72 hours and then remains elevated up to 7-14 days.

20. Troponin Use Therefore it has good utility for retrospectively diagnosing AMI Remember, CK-MB returns to baseline by 48 hours Troponin Early Rise(hrs) Peak (Hrs) Duration (Days) Specficity Sensitivity Tn T 4-6 10-24 10-24 80% >98% Tn I 3-6 1-24 4-7 95% >98%

21. Timing Summary TEST ONSET PEAK DURATION CK/CK-MB 3-12 hours 18-24 hours 36-48 hours Troponins 4-10 hours 18-24 hours Up to 10 days Myoglobin 1-4 hours 6-7 hours 24 hours LDH 6-12 hours 24-48 hours 6-8 days

22. Thank you !