ChemPath: Enzymes and Cardiac Markers
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What are the two types of intracellular enzymes?
• Cytosolic • Subcellular (within organelles)
Describe the order of release of intracellular enzymes when cells are damaged.
Cytosolic are released first, followed by subcellular
In which tissues is ALP present in high concentration?
• Liver • Bone • Intestines • Placenta
What are the most likely sites of pathological ALP increases?
• Bone • Liver
What is an increase in bone ALP caused by?
Increased osteoblast activity
What are other important biomarkers when ALP is raised?
• LFTs • Vitamin D
What technique is used to separate isoenzymes?
Electrophoresis
List some physiological causes of high ALP.
• Pregnancy - 3rd trimester (from placenta) • Childhood - growth spurt
List some causes of very high ALP (>5 x upper limit of normal).
• Bone - Paget’s disease, osteomalacia • Liver - cholestasis, cirrhosis
List some causes of moderately raised ALP (< 5 x upper limit of normal).
• Bone - tumours, fractures, osteomyelitis • Liver - infiltrative disease, hepatitis
Where are ALT and AST found
ALT specific for liver AST found in liver, heart, muscle, kidney
What are 2 causes of high GGT?
• Hepatobiliary disease • Enzyme induction (specifically in alcoholics) (can also be produced in pancreas / kindey)
Causes of elevated LDH
What are two important clincial implications of LDH levels
• LDH raised in haemolysis • Serial LDH levels are taken to assess treatment response in cancers as LDH levels are associated with tumour bulk
Describe the ALP levels in osteoporosis.
It is NORMAL unless there is a fracture.
Which markers are used in acute pancreatitis?
Amylase Lipase
Where else is amylase found?
Salivary glands NOTE: will be raised in parotitis
What is macroamylase
Immunoglobulin binds to amylase, cannot be cleared by kindeys, thereby causing raised benign raised amylase Request amylase electrophoresis for amylase isoenzymes
What are the three forms of creatine kinase?
• CK-MM = skeletal muscle • CK-BB = brain • CK-MB = cardiac muscle
List causes of high CK.
• Muscle damage - rhabdomyolysis, polymyositis/dermatomyositis • Myopathy (e.g. Duchenne muscular dystrophy) • Drugs e.g. statins • MI • Severe exercise • Physiological (Afro-Caribbeans)
Describe the manifestations of statin-related myopathy.
Can range from myalgia to rhabdomyolysis
What are some cardiac and non-cardiac causes of raised troponins
Cardiac • STEMI and NSTEMI • Myocarditis • Aortic dissection • Cardiomyopahty Non-cardiac • PE • Sepsis • Trauma • SAH
Pathological difference between STEMI and NSTEMI
STEMI - Full thickness infarction NSTEMI - partial thickness infarction
What isoform is cardiac troponin
Troponin i