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15 Cards in this Set

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Where do you find the three different types of CK?
MM: largely in muscle
MB: the ‘heart’ form, most concentrated in cardiac tissue
BB: concentrated in the brain, but found in other tissue.
How can you tell if the rise in CKMB is due to skeletal muscle damage?
CKMB/Total CK if this is less than 2.5% then the source is not the heart

Side note: CKMB is a mass measurement while CK is an activity measurement
What are isoforms?
They are different versions of the same isoenzyme CK M+B+ or CK M-B+ for example
What is a macroenzyme?
Aggregation of enzyme molecules with each other or with non-enzymatic proteins may give rise to so-called macro enzymes that can be separated by techniques that depend on differences in molecular size.

ii) These heterogeneous circulating complexes are composed of a normal enzyme linked to immunoglobulin (IgA and IgG) and/or polysaccharide.
If you don't see a rise and fall of an enzyme, what should you think?
Macroenzyme
Why are macroenzymes important?
vi) Macro enzymes are important because they can give false positive results that may influence the Dx of MI or acute pancreatitis. False positives may also lead to further expensive and unnecessary testing.
How should you focus on enzymes?
In a temporal fashion.
How long is an injury in ischemia reversible?
Injury may be reversible for up to 2 hours of ischemia but reperfuse for up to 24 hours
What is the specificity of ECG?
Close to 50-70%
What is the protocol for a patient with a non-diagnostic ECG with chest pain?
iii) Patients with non-diagnostic ECG are observed for 6-8 hours after onset of chest pain and checked to see that serum markers for MI are normal.
What is the only true early marker of an MI?
Myoglobin
What is the immediate marker for MI (more specifically heart cell death)? How long does it stay up?
Troponin I or Troponin T (1 week)
What two things can be late markers for MI?
Troponin and LDH-1
When should you order cardiac markers?
i) On admission

ii) 2-4 hours

iii) 6-9 hours: troponin I should be elevated by this point if there has been MI.

iv)12-24 hours is optional;
What other things can cause high troponin levels?
i) Renal disease—chronic hemodialysis. There is toxic build-up in patients’ blood affecting cardiac cells.
ii) Stroke
iii) Myocarditis
iv) Congestive heart failure
v) Cardiac contusion (any manipulation of the heart or damage of heart tissue)
vi) Sepsis
vii) Trauma