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FINALS CC 2 > M.I. PROFILE/ CARDIAC MARKERS/ CARDIAC ENZYMES > Flashcards

M.I. PROFILE/ CARDIAC MARKERS/ CARDIAC ENZYMES Flashcards

1
Q

Involved in the storage of high-energy creatine phosphate in muscle cells

A

: Creatine Kinase (CK)/ Creatine Phosphokinase

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2
Q

when creatine phosphate is consumed during muscle metabolism →

A

creatinine is generated

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3
Q

Creatinine is excreted at a _______ by the glomerular membrane

A

constant rate

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4
Q

CK is _______ . It is widely distributed, highest activities in _____, _____, _____, and _____

A

NOT HEART SPECIFIC
skeletal muscle, heart, and brain

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5
Q

Creatine kinase would transfer 1 phosphate group from ___ to creatine to form ______ and ___

A

ATP, Creatine phosphate and ADP

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6
Q

Creatine Kinase (CK)/ Creatine Phosphokinase substrates

A

Creatine & ADP

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7
Q

Creatine Kinase (CK)/ Creatine Phosphokinase
products

A

Creatine Phosphate & ADP

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8
Q

Creatine Kinase (CK)/ Creatine Phosphokinase structure

A

Dimeric enzyme; composed of 2 monomer subunits (M or B) M = Muscle and B = Brain

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9
Q

↓ in absorbance at 340 nm is determined; Oxidized NAD

A

Forward Reaction (Tanzer-Gilvarg)

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10
Q

Forward Reaction (Tanzer-Gilvarg) optimum pH

A

Optimum pH is 9.0 (alkaline)

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11
Q

Forward Reaction (Tanzer-Gilvarg) primary enzyme

A

Creatine Kinase

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12
Q

Forward Reaction (Tanzer-Gilvarg) secondary emzymes

A

Pyruvate Kinase, LDH

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13
Q

↑ in absorbance at 340 nm is determined; Reduced NADPH

A

Reverse Reaction (Oliver-Rosalki)

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14
Q

Reverse Reaction (Oliver-Rosalki) Optimum pH

A

Optimum pH: 6.8 (acidic)

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15
Q

Reverse Reaction (Oliver-Rosalki) primary enzyme

A

Creatine Kinase

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16
Q

Reverse Reaction (Oliver-Rosalki) secondary enzymes

A

Hexokinase and G-6-PD

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17
Q

Sources of Error

A
  1. Hemolysis cause false ↑ CK activity
  2. CK is inactivated by light (decreased ↓)
  3. Physical activity and IM injections cause ↑ CK
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18
Q

Creatine Kinase (CK)/ Creatine Phosphokinase Reference Range

A

Male (higher): 15-160 U/L Female: 15-130 U/L
CK-MB: <6% of total CK

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19
Q

CK-3/ CK-MM/
Muscle Type

A

Specific to Skeletal Muscle

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20
Q

CK that has lowest mobility toward the anode (least anodic)

A

CK-3/ CK-MM/ Muscle Type

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21
Q

CK that major isoenzyme in striated muscle and normal serum

A

CK-3/ CK-MM/ Muscle Type

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22
Q

CK-2/ CK-MB/ Hybrid Type

A

Specific to the Heart

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23
Q

CK that is 2nd fastest to migrate toward the anode

A

CK-2/ CK-MB/ Hybrid Type

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24
Q

CK that significant quantities are found in heart tissues

A

CK-2/ CK-MB/ Hybrid Type

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25
Q

CK-1/ CK-BB Brain Type

A

Specific to the Brain

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26
Q

CK that migrate fastest toward the anode (most anodic)

A

CK-1/ CK-BB Brain Type

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27
Q

CK that has Highest conc. in CNS, GI tract, and uterus (pregnancy)

A

CK-1/ CK-BB Brain Type

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28
Q

In normal serum, CK-BB is ______; negligible

A

very low

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29
Q

CK-BB increases when there is damage in the ____ → ____

A

BBB, CSF leakage

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30
Q

The first cardiac enzyme to increase in cases of acute myocardial infarction of all MI markers.

A

CK-MB (hybrid subunit, specific to the HEART)

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31
Q

The first protein to increase in cases of MI is ______ (faster than CK-MB). The first enzyme however is _______

A

myoglobin, CK-MB

32
Q

Has the highest normal value in healthy individuals

A

CK-MM

33
Q

CK-MM is predominant in

A

BLOOD

34
Q

____________ measurement is not diagnostic because CK is _______

A

Total CK enzyme, not specific

35
Q

After MI, CK-MB (>6%) levels begin to rise within ______, peak at _______, and returns to normal levels within ______

A

4-8 hours, 12-24 hours, 48-72 hours

36
Q

1st enzyme to increase is __ → ___→ ___

A

CK → AST → LDH

37
Q

CK REFERENCE VALUES
CK-MM:
CK-MB:
CK-BB:

A

CK-MM: 94-98%;
CK-MB: 2-6%;
CK-BB: very low

38
Q

The CK isoenzyme is coupled/ complexed with antibodies or lipoproteins

A

Macro-CK

39
Q

Farthest to ANODE

A

Mitochondrial CK (CK-Mi)

40
Q

Migrates cathodal to CK-MM; before CK-3

A

CK-Mi

41
Q

Catalyzes the interconversion of lactic and pyruvic acids

A

Lactate Dehydrogenase (LD)

42
Q

Lactate Dehydrogenase (LD) IS widely distributed, highest activities in _____, _____, _____ and _____

A

highest activities in heart, hepatic, skeletal muscle and RBC

43
Q

LD main source for monomers

A

Heart & Skeletal Muscle

44
Q

LD structure

A

Tetramer with 2 active sub-units (H & M active units) H = HEART and M = MUSCLE

45
Q

LD second substrate

A

NAD coenzyme

46
Q

Forward Reaction (Lactate→Pyruvate)

A

WACKER METHOD

47
Q

WACKER METHOD Increase in absorbance is monitored at

A

340 nm (oxidized → reduced NADH)

48
Q

WACKER METHOD optimal pH

A

Optimal pH is 8.3 – 8.9 (basic/ alkaline)

49
Q

Reverse Reaction (Pyruvate→Lactate)

A

WROBLEUSKI LA DUE

50
Q

WROBLEUSKI LA DUE Decrease in absorbance at

A

Decrease in absorbance at 340 nm

51
Q

3x faster but more susceptible to substrate exhaustion

A

WROBLEUSKI LA DUE

52
Q

WROBLEUSKI LA DUE
optimal pH

A

Optimal pH is 7.1–7.4

53
Q

Has greater affinity to H subunits of LDH

A

α-hydroxybutyrate Dehydrogenase (α-HBD)

54
Q

After MI, LD begin to:
RISE within ________
PEAK at ________
REMAINS elevated for _______

A

RISE within 10-24 hours (slowest of all cardiac markers)
PEAK at 48-72 hours or 2-3 days
REMAINS elevated for 10 days (longest to remain elevated)

55
Q

LD reference range

A

100-225 U/L

56
Q

5 LACTATE DEHYDROGENASE (LDH) ISOENZYMES

A

LDH-1 (HHHH)
LDH-2 (HHHM)
LDH-3 (HHMM)
LDH-4 (HMMM)
LDH-5 (MMMM)

57
Q

Fastest to migrate LDH isoenzyme, nearest to the anode

A

LDH-1 (HHHH)

58
Q

MOST ABUNDANT LDH isoenzyme

A

LDH-2 (HHHM)

59
Q

LDH-1 (HHHH) tissues

A

Heart, RBC (Heart Specific)

60
Q

LDH-2 (HHHM) tissues

A

Heart, RBC

61
Q

LDH-3 (HHMM) tissues

A

Lung, Spleen

62
Q

LDH-4 (HMMM) tissues

A

Liver

63
Q

LDH-5 (MMMM)
tissue

A

Skeletal Muscle

64
Q

LDH-1 (HHHH)
disorder

A

MI, Hemolytic Anemia (more significant than LD2)

65
Q

LDH-2 (HHHM)
disorder

A

Renal Infarction,
Megaloblastic Anemia

66
Q

LDH-3 (HHMM) disorder

A

Pulmonary Embolism

67
Q

LDH-4 (HMMM) disorder

A

Hepatic Injury

68
Q

LDH-5 (MMMM)
disorder

A

Skeletal Muscle Injury

69
Q

LDH isoenzyme most abundant to least in serum

A

2>1>3>4>5 (most abundant to least)

70
Q

LDH isoenzyme Flipped Pattern seen on AMI/ Intravascular Hemolysis

A

1>2>3>4>5

71
Q

LDH isoenzyme Muscle & Liver Disorders:

A

5>4>3>2>1

72
Q

LD isoenzyme Lung Disorders (LD3):

A

3>4>2>1>5

73
Q

CK -MB
Appearance
Peak
Stay Elevated

A

4-8 hours
12-24 hrs
3 days

74
Q

AST
Appearance
Peak
Stay Elevated

A

6-8 hrs
24 hrs
5 days

75
Q

LDH
Appearance
Peak
Stay Elevated

A

10-24 hrs
48-72 hrs
10 days

FINALS CC 2 (7 decks)

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