Cardiac enzymes

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Symptoms of coronary blockage may include :
Chest pain or pressure that lasts for more than a few minutes
Pain or discomfort shoulders, neck, arms, or jaw
Chest pain that gets worse
Chest pain that doesn’t get better by rest or by taking
nitroglycerin

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- Cardiac enzymes leak slowly into the blood
High levels of cardiac enzymes may take six or
more hours after the onset of a heart attack
- Pt with chest pain but normal levels of cardiac
enzymes = a heart attack cannot be ruled out
- Repeated cardiac enzymes tests are normally
conducted to confirm diagnosis of a heart attack

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 Blood tests :
- Cardiac enzymes
- Blood gases or other tests to measure oxygen in the
blood
- Complete blood count (CBC)
- Electrolytes (sodium, potassium, chloride)
- Blood lipids (cholesterol and triglycerides)
- Blood sugar (glucose)
- Electrocardiogram (ECG)
- B-type natriuretic peptide (BNP). This is to find stress in
the heart or heart failure after a heart attack.

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* Enzymes as Cardiac Markers:
Creatine kinase (CK or CPK)
Aspartate amino transferase (AST)
Lactate dehydrogenase (LDH or LD)

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* Creatine Kinase :
A cytoplasmic enzyme
CK-1(BB) : Brain
CK-2(MB) :Myocardium
CK-3(MM) :Skeletal muscle ,heart
CK-3 has 3 isoforms :CK-31, CK-32 and CK-33 , CK-2
has 2 isoforms

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Isoenzyme
Composition Present in Elevated in
name

CK-1 BB Brain CNS diseases

Acute
Myocardium
CK-2 MB myocardial
/ Heart
infarction

Skeletal
CK-3 MM muscle,
Myocardium

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 Creatine kinase is an enzyme
CK catalyses the conversion of creatine
Uses ATP to create phosphocreatine (PCr) and
ADP.
This CK enzyme reaction is reversible, such that
also ATP can be generated from PCr and ADP.

Creatine + ATP phosphocreatine + ADP

(Phosphocreatine – serves as energy reserve during
(muscle
contraction)
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-Myocardial infarction
- Cardiac Surgery
- Rapid Tachycardia
- Hypothyroidism
-Trauma
- severe muscle breakdown.
- Recent cocaine use

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Earliest increase 4 - 8 hours
Peak hours 24 - 36 hours
levels of CK can go up in many other
conditions besides a heart attack, it is
not very specific.

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CK-MB : This is a subtype of CK. It is more
sensitive for finding heart damage from a heart
attack. CK-MB rises 4 to 6 hours after a heart
attack. But it is generally back to normal in a day
or two.
Peak hours 15-24

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* Cardiac troponin :
This protein is by far the most commonly used
biomarker.
- It has the highest known sensitivity.
- It enters bloodstream soon after a heart attack.

- Two forms of troponin may be measured :

• troponin T and troponin I.
• Troponin I is highly specific to the heart and stays
higher longer than creatinine kinase-MB.
• It is the best biomarker for finding a heart attack

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Earliest increase 4 - 6 hours
Peak hours 10 - 24
Duration of increase 4 - 7 days

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Myoglobin :
This is a small protein that stores oxygen. It is
measured occasionally. Myoglobin is sometimes
measured in addition to troponin to help diagnose
a heart attack. It is also not very specific for finding
a heart attack.

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Lactate Dehydrogenase (LDH)
A cytoplasmic enzyme found in skeletal muscle,
liver, heart, kidney and red blood cells
5 izoenzymes, composed of 4 subunit peptides of 2
distinct types : M (muscle ), H (heart)

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Not a tissue specific enzyme
In AMI total LD -elevation at 12-18 hr
peak at 48-72 hr
return to baseline level after 6-10 days

Pyruvate Lactate (anaerobic

glycolysis)
LDH is elevated in myocardial infarction, blood
disorders

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LDH isoenzyme determination increases
specificity for cardiac tissue.
LD1 (HHHH)
LD5 (MMMM)
LD2 (HHHM )
LD3 (HHMM )
LD4 (HMMM )
LD1 in heart, kidney (cortex) , red blood cells
LD5 in liver , skeletal muscle

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Isoenzyme Composition Composition Present in Elevated in
name

LDH1 ( H 4) HHHH Myocardium, myocardial

RBC infarction

LDH2 (H3M1) HHHM Myocardium,

RBC

LDH3 (H2M2) HHMM Kidney,

Skeletal
muscle
LDH4 (H1M3) HMMM Kidney,
Skeletal
muscle
LDH5 (M4) MMMM Skeletal Skeletal muscle
muscle, Liver and liver
diseases

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LDH-1 is a clinically sensitive (%90)
marker for infarction when
measured after 24 hr.

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-Aspartate aminotransferase (AST )
Widely distributed in many tissues
Highest concentrations are found in cardiac tissue,
liver and skeletal muscle.
Clinical utility in hepatocellular disorders and skeletal
involvement.
Unuseful in diagnosis of AMI
Beginsto rise within 6-8 hr.
Makes a peak at 24 hr.
Generally returns to normal within 5 days.

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