Transcript Supervised by: Associate professor: Dr. Alaa Abdel Salam Done by:Asma Al – Rashoud.

Supervised by:
Associate professor:
Dr. Alaa Abdel Salam
Done by:Asma Al – Rashoud
421037300
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‫س ْب َحا َن َك َال ِع ْل َم‬
‫ا‬
‫و‬
‫ل‬
‫ا‬
‫ق‬
‫”‬
‫ُ‬
‫َل َنآ إ َّال َما َعل ْم َت َنا إ ِ َّن َك‬
‫َ‬
‫ْ‬
‫علِيِم ُ ا ْل َح ِكيِمُ“ آيه ‪32‬‬
‫أ ْن َت ال َ‬
‫سورة البقرة‬
• Enzymes are specific biologically synthesized
protein that catalyze biochemical reactions
• Cardiac enzymes are those enzymes which
found in the heart muscle with variable values.
• Cardiac enzyme levels are obtained to determine
the presence or absence of some pathological
conditions such as AMI.
• Exercise training effects the cardiovascular and
skeletal muscle systems in a variety of ways to
improve work performance.
1. To provide sufficient information about
cardiac enzymes
2. To expose the relationship between
cardiac enzymes and some pathological
conditions
3. To identify the effect of exercise on
cardiac enzymes
Enzymes
• Definition
Enzymes are functional proteins
that act as biological catalysts.
• Enzyme activity
• Enzyme nature
• Enzyme structure
*
Primary structure
* Secondary structure
*
Tertiary structure
*
Quaternary structure
• Enzyme levels can help provide evidence
of disease process.
• Indicate the location of the abnormality.
• Assess the extent and severity of the illness.
• Identify the probable cause of the condition
• Enzyme Values are usually expressed in
terms of activity.
Factors Influence Enzymatic
Reactions
• Substrate concentration
• Enzyme concentration
• pH
• Temperature
• Cofactors
• Inhibitors
Cardiac Enzymes
1- Creatine Kinase ( CK )
2- Lactic Dehydrogenase (LD)
3- Aspartate aminotransferase (AST), also
called glutamic – oxaloacetic
transaminase ( GOT ).
4- Alanine aminotransferase (ALT), also
called glutamic – pyruvic transaminase
(GPT)
5- Hydroxybutyric dehydrogenase ( HBD )
Creatine Kinase
• Tissue Source
– Higher Values found in skeletal muscle, heart muscle
and brain tissue,
– Smaller quantities in bladder, gastrointestinal tract,
thyroid, lung, liver and pancreas.
• CK Isoenzymes
– Ck – MM
– CK – BB
– CK – MB
• CK Values
– 40 to 175 U/L for men.
– 25 to 140 U/L for women.
Lactate Dehydrogenase (LD)
• Tissue Sources
– High Activities are found in the heart, the liver,
skeletal muscle, the kidney and red blood cells.
– Lesser amount in the lung, smooth muscle and the
brain.
• LD Isoenzyme
–
–
–
–
–
LD -1
LD – 2
LD – 3
LD – 4
LD – 5
• LD values
– Total LDH levels normally rang from 48 to 115 U/L.
Isoenzyme Relationship in
Normal Pattern
90
80
70
60
LD 1
LD 2
LD 3
LD 4
LD 5
50
40
30
20
10
0
LD 1
LD 2
LD 3
LD 4
LD 5
Asparate Aminotransferase
• Tissue Source
– Highest Concentration are found in
cardiac tissue, the liver and skeletal
muscle.
– Smaller amounts found in the kidney, the
pancreas, and red blood cells.
• Values
– AST Levels range from 8 to 20 U/L
Alanine Aminotransferase
• Tissue Source
– Is found in high concentrations in the
liver.
• Values
– Range from 10 to 32 U/L in women.
– Range from 9 to 24 U/L in men.
Hydroxybutyric
Dehydrogenase ( HBD(
• Tissue Source
– ( HBD ) is found in highest
concentrations in heart muscle, kidney,
brain and red blood cells.
• Values
– ( HBD ) vales rang from 114 to 290 U/L
Relation between Cardiac
Enzymes and Heart Disease
• Myocardial Infarction
Definition
Myocardial infarction: condition caused
by partial or complete occlusion of one
more coronary arteries.
Relationship between Cardiac
Enzymes and AMI
• After an infarction the serum activity of CK is
increased from about 6 – 72 hours with a peak
at 24 hours.
• LD is increased from 1 to 10 days after
infarction, with a peak at 2 days.
• AST is elevated from about 0.5 to 5 days with a
peak at 24 hours.
• HBDH levels begin to rise 8 – 10 days following
M.I with peak levels about 48 – 96 hours.
•
Effect of Exercise on the
Body
Circulatory System
– Heart rate
– Systolic blood pressure
– Diastolic blood pressure
• Respiratory System
– Oxygen uptake
– Stork Volume
– Ventilation
– Respiratory Rate
• Musculoskeletal System
– Muscle Strength
– Bone Mass
– Cardiac output
– Coronary blood flow
– Muscle blood flow
• CK levels may be elevated for as long as
48 hours following exercise.
• The predominant isoenzyme is CK-MM.
• LDH increased in the period following
exercise with a rapid rise and fall.
• AST increased following exercise.
• ALT increased after exercise.
• To the technician: when you perform
cardiac enzymes test to patient already
made exercise you must be keep in your
mind the result of the test will be come
higher than the realistic values.
• To the physical therapist: you must be
encourage your patient to do exercise
prudently within his endurance since the
benefits of exercise exceed the risks
• To the patient: you have to do exercise to
improve your performance.