14. Cardiac Disease and Markers
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ECG checks for what 5 things?
• Rate • Rhythm • Axis • Hypertrophy • Infarction
Drug that controls arrhythmias?
Digoxin
Main cause of cardiac ischemia?
Coronary atherosclerosis
Caused by hemolytic streptococcus induced immune reaction
Valvular disease
CKMB relative index indicating myocardial damage?
> 3%
CKMB relative index indicating skeletal muscle damage?
< 3%
CKMB relative index formula
(CKMB/Total CK) * 100%
BNP stimulus release
Ventricular stretch and increased volume
3 reasons for increased CK?
• Myocardial diseases (AMI) • Skeletal muscle disease/injury (alcohol abuse) • Cerebral injury, meningitis
2 methodologies for CKMB?
• Enzyme immunoassay - Electrophoresis
Troponin methodology?
Chemiluminescence sandwich antibody assay
Troponin rise, peak, fall window
4-6 hrs 12-24 hrs By 7 days
Troponin RI
< 0.04 ug/L
Troponin range indicating possible MI, repeat in 6-8 hrs?
0.05 - 0.49 ug/L
Myoglobin rise, peak, fall window
1-4 hrs 8-12 hrs 24 hrs
CK rise, peak, fall window
4-6 hrs 12-24 hrs 48 hrs
Sac around heart that anchors it to diaphragm
Pericardium
6 properties of an ideal cardiac marker
• Specific for myocardial injury • Sensitive to small injuries • Rapidly released following injury • Around long enough in blood to permit diagnosis • Produce blood levels proportional to infarct size • Be technically easy to assay
Negative predictor of myocardial damage
Myoglobin
Lactate dehydrogenase rise, peak, fall window
36-48 hrs 72 hrs 7-12 days
Effects of BNP on blood vessels
Vasodilation
Which troponin unit is most specific for cardiac
Troponin I
Which troponin unit peaks soonest in myocardial damage
Troponin I
Which troponin unit remains high the longest
Troponin T