Transcript Cardiac Enzymes

Cardiac Enzymes
By Michael W. Bowers
CK-MB 3hr, peak 12-24hr lasts 1-3 days
Troponin 3-12 hrs, peak 12-24hr, lasts 8-21 days Trop-T and 7-14 Trop-I
What is Creatine Kinase?
What is Creatine Kinase?
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Creatine kinase is an enzyme
CK catalyses the conversion of creatine
Uses ATP to create phosphocreatine (PCr) and ADP.
This CK enzyme reaction is reversible, such that also ATP can be
generated from PCr and ADP.
• PCr serves as an energy reservoir for the rapid buffering and
regeneration of ATP in situ and for intracellular energy transport
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Where, Oh Where, is Creatine Kinase MB
Isoenzyme?
Will
Where, Oh Where, is Creatine Kinase MB
Isoenzyme?
• Myocardium
• 1-2% in
– Skeletal Muscle
– Tongue
– Small intestine
– Diaphragm
What Causes Creatine Kinase Levels to Rise?
What Causes Creatine Kinase Levels to Rise?
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Myocardial infarction
Cardioversion
Cardiac Surgery
PCI Hello Cath Lab!
Rapid Tachycardia
Hypothyroidism
Extensive Trauma
Rhabdomyolysis (severe muscle breakdown)
Muscular dystrophy
Myopericarditis
Recent cocaine use
OK Kids, Let’s Talk Troponin
Troponin
• Troponin is a complex of three regulatory
proteins
– Troponin C, troponin I and troponin T
• Integral to muscle contraction in skeletal and
cardiac muscle, but not smooth muscle
• More Cardiac Sensitive and Specific than CKMB
Troponin
Troponin
• Released during MI from myocytes
• Heart Muscle Breaks Down
• Its subsequent release is prolonged with
degradation of actin and myosin filaments
• It released in 2–4 hours and persists for up to
7 days.
Diff DX of Elevated Troponin
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Acute infarction,
Renal failure
Severe pulmonary embolism causing acute right heart overload
Heart failure
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Myocarditis.
Tachy- or bradyarrhythmias, or heart block
Hypertrophic cardiomyopathy
Cardiac contusion or other trauma including surgery, ablation, pacing, implantable
cardioverter-defibrillator shocks, cardioversion, endomyocardial biopsy, cardiac surgery,
following interventional closure of atrial septal defects
Aortic dissection
Aortic valve disease
Apical ballooning syndrome - Takotsubo Cardiomyopathy
Rhabdomyolysis with cardiac injury
Critically ill patients,
– especially with diabetes, respiratory failure or sepsis
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Acute neurological disease
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stroke or subarachnoid hemorrhage
Infiltrative diseases
– amyloidosis, hemochromatosis, sarcoidosis, and scleroderma
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Inflammatory diseases
– myocarditis or myocardial extension of endo-/pericarditis, Kawasaki disease
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Burns, especially if affecting >25 percent of body surface area
Extreme exertion
Timing
• Cardiac enzymes leak slowly into the blood
• High levels of cardiac enzymes may take six or
more hours after the onset of a heart attack
• Pt with chest pain but normal levels of cardiac
enzymes = a heart attack cannot be ruled out
• Repeated cardiac enzymes tests are normally
conducted to confirm diagnosis of a heart
attack
CK-MB 3hr, peak 12-24hr lasts 1-3 days
Troponin 3-12 hrs, peak 12-24hr, lasts 8-21 days Trop-T and 7-14 Trop-I
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Hurst’s The Heart
Up to date
http://www.publicsafety.net/serum.htm
ucl.ac.uk
homemed.co.za
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www.duhs.edu.pk/curriculum
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