Pemeriksaan

Laboratorium
Penyakit
Kardiovaskular
miftahul arifin,dr.SpPK
3
 Katagori LDL, HDL, CHOLESTEROL

LDL CHOLETEROL
< 100 Normal
100 – 129 Normal tinggi
130 – 159 Borderline tinggi
160 – 180 Tinggi
≥190 Sangat tingggi
HDL CHOLESTEROL
< 40 Rendah
≥ 60 Tinggi

CHOLESTEROL
< 200 Diinginkan
200 – 239 Borderline tinggi
≥ 240 Tinggi
 Diagnosis

MI is usually diagnosed by a history

of :
 crashed chest pain (angina
pectoris) due to reduction of
coronary perfusion
 ECG changes characteristic of an
MI (fig) ;
 and the release of myocardial
enzymes are observed.
 Laboratory findings
Three enzymes are commonly
used in the diagnosis and
follow-up of the MI are:
 creatine kinase (CK)
 aspartate aminotransferase
(AST)
 lactate dehydrogenase (LDH)
Creatine Kinase
(CK)
CK is also released from
damaged skeletal muscle
(CK-MM). But its isoenzyme in
myocardial cells (CK-MB) is
more specific indicator,and
its increase is used in the
investigation of MI.
 AST & LDH
AST and LDH releases are not
specific to cardiac muscle because :
 AST is also found in many acute
pathologies affecting the liver and
skeletal muscle
 LDH is also found in liver and red
cells
 Note that :
 in the first four hours after
the infarction the enzymes
may not be raised.

 the development of cardiac

arrhythmia is a major cause
of death in these patients.
 Other Biochemical
Indicators
Two other tests are useful in
MI ：

 Myoglobin : it is detectable 1-
3 hours after infarction. It may
be the earliest indicator in MI.
 Troponin I and T ( TnT, TnI)
They are highly sensitive and
specific markers for acute MI.
They are released from
damaged cardiac muscle cells
within 3-12 hours of the
infarction, but they remain
elevated for much longer (5-10
days and 2 weeks respectively).
 CK （ MB ） AST troponin LDH

Normal value 25-175 IU/L 5-40 IU/L <1.0 ng/mL 90-200 IU/L

Elevate time 3-6h 6-10h 4h 24-72h

peek 18h 12-48h 2-3d 3-4 d

Return normal 2-3 days 3-4 days 7-14 days 14days

 Parameter Lab. utk
Penyakit Jantung
 Creatinin Kinase (CK) √
 Creatinin Kinase Myocard Band (CKMB) √
 Lactat Dehydrogenase (LDH) √
 Serum Glutamic Oxaloacetic Transaminase (SGOT) √
 Cardiac Troponin T (cTnT) √
 Cardiac Troponin I (cTnI) √
 Myoglobin √
 High Sensitivity C Reaktif Protein (hsCRP)
 N Terminal pro B type Natriuretic Peptide (NT pro-
BNP)
 Brain Natriuretic Peptide (BNP)
 CK (Creatinin Kinase), CKMB (Creatinin
Kinase Miokard Band), LDH (Lactat
Dehydrogenase), cTn-T (Cardiac Troponin T),
cTn-I (Cardiac Troponin I), Mioglobin.

Petanda IMA & Non IMA

Hs CRP (High Sensivity C-reactive Protein), BNP (Brain

Natriuretic Peptide), Pro BNP (Pro-Brain Natriuretic Peptide),
Homocystein
 HUBUNGAN CRP / hs-CRP dengan PKV / PJK
ATEROSKLEROSIS :
kadar terendah bukan sebab jantung
 plaque stabil
> plaque erosif
nyata  plaque ruptur
PKV STABIL :
hs-CRP tidak tergantung trombosis

INDIVIDU SEHAT / ASIMTOMATIK

korelasi kuat independent kadar CRP stabil PJK long –ter m
( RR = 2,0 ; confidence interval = 1,6- 2,5)
batas  risiko 1,5 – 4 x ;  sedang risiko 3- 6 x
 E. Peranan hs-CRP sebagai Faktor Risiko PJK

 Metoda yang sangat sensitif  mengukur

CRP dalam kuantitas yang kecil  Hs- CRP
 1. hs-CRP berkorelasi erat dengan
risiko
kejadian PJK,kekambuhan & sudden
death.
2. hs-CRP secara konsisten
meramalkan
kejadian koroner baru pada
Unstable
angina dan IMA
-hs-CRP: sensitivitas analitik: 0,1 mg/L

- Kadar sebagai prediktor 1-5mg/L

- Prediktor terbaik dibanding faktor risiko lainnya pada

PJK spt Lp(a), LDLC,Homocystein, ratio TC/HDL

- Sebagai pemeriksaan skrining: - validasi yang baik

- tidak mahal
- widely available
Diharapkan pemeriksaan Hs-CRP sbg tes skrining dpt memotivasi:
modifikasi gaya hidup spt penurunan BB dan kontrol rutin DM

Penurunan CRP
 Chronic Heart Failure (CHF): The tip of
the
ice berg = end stage
of heart disease
CHF
proBNP, TnT;
Digoxin, Digitoxin Myocardial
Injury
AMI
Troponin T, CK, CK-MB,
Myoglobin, LDH, AST(GOT) Thrombosis
Acute coronary syndromeInflammation
Troponin T, hsCRP, Fibrinogen D-dimer,
AT III, Protein C, Protein S, APC-resistance
Antioxidative
Coronary heart disease Potential
Atherosclerosis Lipid
Cholesterol, LDL, HDL, Tg, Lp(a), Apo-A1, Apo-B, Glucose, HbA1c
Status
Fructosamine, Insulin, Albumin, Homocysteine, Vitamin B12, Folate, hsCRP

Risk factors Diabetes

Family History, Age, Gender, Smoking, Physical Inactivity, Hypertension, Obesity,
Type 2
Insulin Resistance, Diabetes, Thrombophilia, High Cholesterol, High Homocysteine,
Thank you