Cardiac Function Test
 Diagnosis of coronary artery diseases, particularly the
myocardial injury caused by ischemia
 Developed to analyze the myocardial function on a more
comprehensive level where the more insight physiological
and pathological information can be extracted
 Provides a more significant meaning and higher efficacy
than what the conventional EKG can provide
 Valuates the function of the myocardium directly, it can
detect any early subtle changes in myocardial function or
injuries caused by the obstruction of small coronary
arteries which cannot be detected by catheterization or
angiography
C-REACTIVE PROTEIN TEST
 An inflammatory marker
 Provides information about a patient’s risk of having a
heart attack or stroke
 High levels of CRP in the blood mean there is
inflammation somewhere in the body
CARBON DIOXIDE CONTENT
 Used as an investigative and diagnostic tool for patients
with breathing problems
COMPLETE BLOOD COUNT
 Information about the types of blood cells present
 Condition and number (percentage) in relation to other
cells
ELECTROLYTE PANEL
 Measure the amount of potassium, sodium, chloride and
carbon dioxide levels in the blood
ERYTHROCYTES SEDIMENTATION RATE
 Measures the rate at which red blood cells separate from
plasma
 High levels may occur during a heart attack, rheumatic
fever, giant cell arteritis, severe anemia, cancer relapse or
other conditions
 Low levels may be associated with heart failure, sickle
cell anemia or other conditions
CARDIAC ENZYME TESTS
 Creatine kinase-MB
 Lactate dehydrogenase
 Troponin
Creatine kinase-MB
 An elevation in value indicates myocardial damage
 An elevation occurs within 4 to 6 hours and peaks 18 to
24 hours following an acute ischemic attack
 Normal value is 0% to 5% of total; total CK is 26 to 174
units/L
 It catalyze the transfer of a phosphate group between
creatine phosphates and adenosine diphosphate
 Involved in the storage of high energy creatine pO4 in the
muscles
 Composed of pair of monomers, M and B
 CK-MM, CK-BB, CK-MB
 CK-MM- major isoenzymes (94-100%)
 CK-BB- brain type, rare in adult due to high molecular
size
 CK-MB- hybrid type, myocardium is the only tissue that
releases in significant quantities (20%), sensitive indicator
of AMI
 Following AMI, levels rise within 4-8 hours, peak at 12-
24 hours and normalize in 48-72 hours
Lactate dehydrogenase
 Catalyze the interconversion of lactic and pyruvic acids
tetramic which contains 4 subunits (H and M forms)
 Elevations in LDH levels occur 12-24 hours following MI
and peak in 48 to 72 hours. Remains elevated in 10-14
days
 Normally LDH 1 is lower than LDH 2
Troponin
 Composed of 3 proteins- troponin C, cardiac troponin I,
and cardiac troponin T
 Troponin I especially has a high affinity for myocardial
injury
 Rises within 3 hours and persists for up to 7 days
 Normal values are low, with troponin I being lower than
0.6 ng/mL and troponin T normally ranging from 0 to 0.2
ng/mL
 Any rise can indicate myocardial cell damage
Myoglobin
 An oxygen-bnding protein found in cardiac and skeletal
muscle
 Level rises within 1 hour after cell death, peaks in 4 to 6
hours
 Returns to normal within 24 to 36 hours
1. Creatine Kinase- enzymes that is involved in the transfer
of energy in muscle metabolism
- Has 3 isoenzymes: CK-MM, CK-MB, CK-BB in
electrophoresis. The fastest migrating is BB (CK1), MB
(CK2), then MM (CK3)
- CK-MB – diagnosis of acute myocardial infarction since
its high specificity for cardiac injury
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2. AST- first marker used for the laboratory diagnosis of  D-Dimer measurement has been validated in the
acute myocardial infarction. It lacks specificity following:
3. Lactate dehydrogenase (LD) - cytoplasmic enzyme found - Exclusion of venous thromboembolism (VTE) in
in almost all cells of the body and not specific also for MI certain patient populations:
 This begins to rise at 6 hours- 12 hours from the onset of  Deep vein thrombosis (DVT)
shest pain, peaks 1-3 days and normalize within 8 days  Pulmonary embolism (PE)
 LD1 and LD2 are subfractions that are specific for the - Prediction of recurrent VTE and risk stratification
heart of patients for VTE recurrence
- Diagnosis and monitoring of disseminated
Abnormal CK Types intravascular coagulation (DIC)
 Macro-CK – is a CK-Ig complex. On electrophoresis it  Normal range: <0.50mg/L (ug/mL = mg/L)
migrates between MM and MB. It is found in completely
healthy elderly women
 Mitochondrial CK – migrates very close to MM, usually
slower than MM. it is seen in patients with advanced often
disseminated, malignancies and is associated in poor
prognosis.

Troponin T (TnT) – an asymmetrical globular protein

 Allows for both early and late diagnosis of acute
myocardial infarction. Rise after few hours onset of pain
and peak by 2 days.
 Clearly differentiate cardiac damage with muscle damage

Troponin I (TnI)
 Basic globular proteins- found only in the myocardium in
adult and sensitive measure of cardiac injury. Not found in
stress related activity but only in MI
 Increased 3-8 hours after onset of pain, peaks 12-24 hours
 Widely available for use in clinical diagnosis
 Highly cardiospecific than TnT
 Not elevated in skeletal muscle injury and vigorous
exercise

Troponin C
 Dumbbell-shaped proteins but not heart specific
 Cardiac Myosin Light Chains (MLC)
 Specific myocardial proteins and consider specific for
cardiac injury than CK-MB or LD determinations

D-Dimer
 Marker of fibrinolysis
 Protein that is released into the circulation during the
process of fibrin clot breakdown
 Specific product of cross-linked fibrin degradation by
plasmin
 Measurement of D-Dimer may indicate a disturbance of
the balance between the two processes of coagulation
and fibrinolysis

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