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DS Unit 4 > Cardiac Enzymes > Flashcards

Cardiac Enzymes Flashcards

1
Q

What are the cardiac enzyme markers?

A 
1. Creatine Kinase (CK)
A. Total
B. CK-MB
2. Troponin T
3. Troponin I
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2
Q

What are the normal ri for total Creatine kinase?

A 
1. Adult/elderly
A. Male : 55 – 170 units/L 
B. Female : 30 – 135 units/L
2. Newborn: 65 – 580 units/L
3. Values higher after exercise
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3
Q

What are the indications for testing creating kinase?

A
  1. Used to support diagnosis of myocardial infarction

2. Can also indicate neurologic or skeletal muscle diseases

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4
Q

Where is creatine kinase located?

A

Heart muscle
Skeletal muscle
Brain

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5
Q

Why is creatine kinase used as a clinical marker?

A

Elevation occurs when muscle or nerve cells are injured

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6
Q

What is the timing of creatine kinase elevation?

A

Rise within 6 hours
Peak @ 18 hours
Back to baseline 2 -3 days

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7
Q

What is an isoenzyme?

A

One of a group of enzymes that are very similar in catalytic properties but differ by variations in physical properties:
A. Isoelectric point
B. Electrophoretic mobility

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8
Q

What are the creatine kinase isoenzymes? How are they differentiated?

A 
CK BB (CK 1)
CK MB (CK2): cardiac
CK MM (CK3)
Electrophoresis
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9
Q

Where is creatine kinase BB located?

A

Brain
Lung
Think BB: Brain and Breathing

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10
Q

What is Creatine BB a clinical marker of?

A 
1. Diseases that affect the CNS
A. Stroke, brain injury, brain cancer, subarachnoid hemorrhage, seizures, shock
2. Pulmonary Infarction 
3. Adenocarcinoma of lung
4. Electroconvulsive therapy
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11
Q

Where is creatine kinase MB located?

A

Myocardial Cells

Skeletal Muscle
Small amounts

MB: think myocardium and Body

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12
Q

What is Creatine MB a clinical marker of?

A

Myocardial Infarction

Ventricular arrhythmia

Cardiac ischemia

Myocarditis

Cardiac surgery

Cardiac defibrillation

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13
Q

What is the timing of elevation of creatine kinase MB?

A
  1. Rise 3-6 hours after MI
  2. Peaks 12- 24 hours
  3. Back to baseline 12-48 hours after MI
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14
Q

What are the clinical priorities for creatine kinase MB?

A
  1. CK-MB helpful in quantifying:
    A. Degree of MI
    B. Onset of infarction
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15
Q

Where is creatine kinase MM located?

A

Skeletal muscle
Varies according to a person’s muscle mass

CK-MM think Muscle Mass

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16
Q

What is Creatine MM a clinical marker of?

A 
Myopathies
Vigorous exercise
Multiple intramuscular injections
Electroconvulsive therapy
Cardioversion
Recent surgery
Crush injuries
17
Q

Which isoenzyme makes up the most of total creatine kinase

A

CK-MM

18
Q

What are the normal ranges of trop T?

A

<0.2 ng/ml

19
Q

What are the normal ranges of trop I?

A

<0.03 ng/ml

20
Q

What are some differences between Trop T and trop I?

A

Trop T remains elevated longer than Trop I; also Trop T generally has a higher peak than Trop I

21
Q

What are the indications for troponin testing?

A
  1. Blood assay performed on patients who present with chest pain
    A. Specific indicator of cardiac muscle injury
    -Rule in or rule out cardiac ischemia
  2. Helpful in predicting clinical outcome of patient with acute myocardial infarction
    A. Higher the level, the more significant the injury to cardiac muscle
22
Q

How can skeletal muscle troponins be separated from cardiac troponins?

A

use of monoclonal antibodies or enzyme-linked immunosorbant assays (ELISA)

23
Q

Why are troponin levels measured?

A

Troponins are proteins that exist in skeletal and cardiac muscle
Regulate calcium dependent interaction of myosin with actin for muscle contraction

24
Q

What are cardiac troponins similar to?

A

CK-MB

25
Q

What are cardiac troponins specific for?

A
  1. cardiac troponins are highly specific for myocardial cell injury:

A. Cardiac troponins will always be normal in noncardiac disease

B. Cardiac troponins become elevated sooner and remain elevated longer than CK-MB

C. Cardiac troponins are more sensitive to cardiac muscle injury than CK-MB

26
Q

What is the timing of elevation for cardiac troponins?

A
  1. Elevate as early as three hours after myocardial injury
  2. Troponin I can remain elevated for 7-10 days after myocardial infarction
  3. Troponin T can remain elevated for 10-14 days after event
27
Q

Why are cardiac troponins not useful in diagnosing recurrent MI?

A
  1. Due to the longer period of time that troponins are elevated, they are not useful in diagnosing recurrent MI
    A. May be elevated from first cardiac event
28
Q

What is the clinical significance of cardiac troponins?

A
  1. Cardiac vs noncardiac chest pain
    A. Helpful when EKG and CK-MB results are not classic for myocardial infarction
    B. Unstable angina may have slightly elevated troponins
    C. If cardiac troponin is normal, chest pain is noncardiac
29
Q

How are cardiac troponins useful in estimation of MI size?

A

Elevated troponin levels at four weeks post MI are inversely proportional to left ventricular ejection fraction: low ejection fraction due to massive MI

30
Q

How are cardiac troponins useful in detection of reperfusion associated with coronary recanalization?

A

“Washout” or second peak of cardiac troponin accurately indicates reperfusion after a stent is placed to open up an artery

31
Q

How are cardiac troponins useful in detection of peri-operative MI?

A
  1. Since cardiac troponins are not affected by skeletal muscle injury, they are a good indicator of myocardial infarction in the perioperative period
  2. CK MB may be elevated secondary to skeletal muscle injury
32
Q

When are troponin levels falsely elevated?

A

Dialysis pts

DS Unit 4 (9 decks)

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