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1.kuliah Ums Enzym Jantung 2020
1.kuliah Ums Enzym Jantung 2020
Cardiac Disease
ACUTE CORONARY SYNDROME
(ACS)
Ischemic heart diseases (acute coronary syndrome) includes:
1-Angina
2-Unstable angina
3-Myocardial infarction: most serious form of ischemia that leads to
injury or even death of myocardium.
The most common cause of myocardial ischemia is atherosclerosis.
Risk factors for Coronary Artery Disease:
1-Age
2-Gender
3-Family history
4-Hyperlipidemia
5-Smoking
6-Hypertension
7-Diabetes
8-Obesity
9-High plasma homocysteine levels
CRITERIA FOR DIAGNOSIS OF ACS
Triad of criteria:
Clinical picture
Severe & prolonged chest pain
Atypical pain (epigastric)
Silent ischemia.
ECG changes consistent with acute MI
Elevated serum cardiac MARKERS
Diagnosis requires at least two of them.
CARDIAC MARKERS MUST
BE:
RECENT Traditional
CK-MB (mass) AST activity
LDH activity
c.Troponins (I or T)
LDH isoenzymes
Myoglobin
CK-Total
Low MW protein
Skeletal & cardiac muscle Mb identical
Serum levels increase within 2h of muscle damage
Peak at 6 – 9h
Normal by 24 – 36h
Excellent NEGATIVE predictor of myocardial injury
– 2 samples 2 – 4 hours apart with no rise in levels virtually
excludes AMI
Rapid, quantitative serum immunoassays
CARDIAC TROPONINS
becomes patent
Unsuccessful Peak concentrations earlier &
reperfusion
at higher levels if reperfusion
successful
Time
Due to short plasma half life (t½ = 10 min) Myoglobin is considered the
best re-perfusion marker
BIOCHEMICAL MARKERS IN ACS
CURRENT RECOMMENDATIONS