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Nancy Chen Group 5 June 17, 2012 Troponin I, Total Creatinine Kinase (CK), and Creatinine Kinase (MB

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Troponin I The troponin test measures the levels of certain proteins called troponin T and troponin I in the blood. These proteins are released when the heart muscle has been damaged, such as a heart attack. The more damage there is to the heart, the greater the amount of troponin T and I there will be in the blood.

The test may be done along with other cardiac marker tests, such as CPK isoenzymes or myoglobin. Normal Values Cardiac troponin levels are normally so low they cannot be detected with most blood tests. Your test results are usually considered normal if the results are: Troponin I: less than 10 µg/L Troponin T: 0–0.1 µg/L Normal troponin levels 12 hours after chest pain has started mean a heart attack is unlikely. What abnormal results mean An increase in the troponin level, even a slight one, usually means there has been some damage to the heart. Significantly high levels of troponin are a sign that a heart attack has occurred.

Most patients who have had a heart attack have increased troponin levels within 6 hours. After 12 hours almost everyone who has had a heart attack will have raised levels. Troponin levels may remain high for 1 to 2 weeks after a heart attack. Increased troponin levels may also be due to:   Abnormally fast heart beat High blood pressure in lung arteries (pulmonary hypertension) Blockage of a lung artery by a blood clot, fat, or tumor cells (pulmonary embolus) Congestive heart failure Coronary artery spasm

Why the test is performed The most common reason to perform this test is to determine if chest pain is due to a heart attack. Your doctor will order this test if you have chest pain and signs of a heart attack. The test is usually repeated two more times over the next 12 to 16 hours. The troponin test may also be done to help detect and evaluate other causes of heart injury.

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Total Creatinine Kinase (CK) How the test is performed Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood. Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding. Why the test is performed This test is done if a CPK test reveals that your total CPK level is elevated. CPK isoenzyme testing can help pinpoint the exact source of the damaged tissue. CPK is made of three slightly different substances:

CPK-1 (also called CPK-BB) is found mostly in the brain and lungs

CPK-2 (also called CPKMB) is found mostly in the heart CPK-3 (also called CPKMM) is found mostly in skeletal muscle

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Electroconvulsive therapy Pulmonary infarction

Inflammation of the heart muscle usually due to a virus (myocarditis)

Higher-than-normal CPK-2 levels: CPK-2 levels rise 3 - 6 hours after a heart attack. If there is no further heart muscle damage, the level peaks at 12 - 24 hours and returns to normal 12 - 48 hours after tissue death. Increased CPK-2 levels may also be due to:  Heart defibrillation (purposeful shocking of the heart by medical personnel) Heart injury (for instance, from a car accident)

What abnormal results mean Higher-than-normal CPK-1 levels:  Because CPK-1 is found mostly in the brain and lungs, injury to either of these areas can increase CPK-1 levels. Increased CPK-1 levels may be due to: Brain injury (due to injury, stroke, or bleeding in the brain)

CPK-2 levels do NOT usually rise with chest pain caused by angina, pulmonary embolism (blood clot in the lung), or congestive heart failure. Higher-than-normal CPK-3 levels are usually a sign of muscle injury or muscle stress and may be due to:   Muscle damage due to drugs or being immobile for a long time (rhabdomyolysis) Myositis (skeletal muscle inflammation)

Creatinine Kinase MB How is it used? CK–MB levels, along with total CK, are tested in persons who have chest pain to diagnose whether they have had a heart attack. Since a high total CK could indicate damage to either the heart or other muscles, CK–MB helps to distinguish between these two sources. When is it ordered? CK-MB is usually ordered along with total CK in persons with chest pain to determine whether the pain is due to a heart attack. It may also be ordered in a person with a high CK to determine whether damage is to the heart or other muscles. Increased CK-MB can usually be detected in heart attack patients about 3-4 hours after onset of chest

pain. The concentration of CK-MB peaks in 18-24 hours and then returns to normal within 72 hours. What does the test result mean? If the value of CK-MB is elevated and the ratio of CK–MB to total CK (relative index) is more than 2.5–3, it is likely that the heart was damaged. A high CK with a relative index below this value suggests that skeletal muscles were damaged.

Bibliography CK-MB: The Test | Creatine Kinase-MB. (n.d.). Lab Tests Online: Welcome!. Retrieved June 18, 2012, from http://labtestsonline.org/understanding/analytes/troponin/tab/glance CPK isoenzymes test - PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved June 18, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0003075 MDA / Quest Vol 7 No 1 / Simply Stated . . .The Creatine Kinase Test. (n.d.). Welcome to MDA | Muscular Dystrophy Association. Retrieved June 18, 2012, from http://www.mdausa.org/publications/quest/q71sscktest.html Troponin test - PubMed Health. (n.d.).National Center for Biotechnology Information. Retrieved June 18, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004692 Troponin test: MedlinePlus Medical Encyclopedia. (n.d.). National Library of Medicine - National Institutes of Health. Retrieved June 18, 2012, from http://www.nlm.nih.gov/medlineplus/ency/article/007452.htm