Cardiac Function

The Heart
• The heart is a muscular organ
responsible for pumping blood through
the blood vessels by repeated,
rhythmic contractions.
• Size of human fist
• Weighs 250-350 g
• The primary function of the heart is to
pump blood in order to generate and
sustain an arterial blood pressure
necessary to provide adequate perfusion
of organs.
• The laboratory has been used primarily to
assess cardiac disease, such as acute
myocardial infarctions (AMIs), and offer body
chemistry information to aid supportive cardiac
therapy.
• Use of laboratory results still supports diagnosis
of AMI but also assesses risk for future cardiac
disease
• This is performed through analysis of body
chemistry metabolites, such as total cholesterol,
high-density lipoprotein cholesterol, and high-
sensitivity C-reactive protein.
• Risk factor assessment enables health-care
professionals to educate the patient and to start
activities that will reduce risk for an AMI.
 Heart Disease
• Congenital heart disease
• Congestive heart failure
• Coronary heart disease
• Hypertensive heart disease
• Infective heart disease
 Common Symptoms of Heart Disease

• Dyspnea‫لتنفس‬33‫يقا‬33‫ض‬
• Chest pain
• Cyanosis ‫لزرقة‬33‫ا‬
• Palpitations‫لخفقان‬33‫ا‬
• Fatigue‫لتعب‬33‫ا‬
• Edema
 Diagnosis of Heart Disease
• Single diagnostic laboratory test that assess
cardiac function does not exist
• The ideal marker for heart disease should
have the following criteria:
1. It should be absolutely heart specific.
2. It should be highly sensitive to detect even minor
heart damage.
3. It should be able to differentiate reversible from
irreversible damage.
4. In acute myocardial infarction "AMI" the marker
should estimate infarct size and prognosis.
5. The marker should be stable, rapid and easy to
perform and cost effective.
 Laboratory Diagnosis of AMI
Enzymes
• Creatine kinase "CK"
• Involved in the transfer of energy in
muscle metabolism.
• Isoenzymes CK-BB, CK-MB & CK-MM
• CK-MB "CK2" isoenzyme is the most
specific for cardiac muscle eventhough it
accounts for only 3-20% for total CK
activity in the heart.
• Total CK activity in early AMI has
great specificity "80%".
• CK-MB takes 4-6 h from onset of
chest pain before it can be detected
in significant levels.
• Peak levels occur at 12-24 h, it
returns to normal in 2-3 days.
• CK-MB mass assay
• It measures the protein concentration of
CK-MB rather than its catalytic activity.
• Laboratory procedures are based on
immunoassay techniques using monoclonal
antibodies.
• It is more sensitive and have fewer
interferences than activity-based assays.
• Mass assays can detect an increased
serum concentration of CK-MB about 1 h
earlier than activity-based assay.
 Cardiac Proteins
• Myoglobin
– It is more sensitive than CK and CK-
MB activities during the first hours after
chest pain onset.
– It starts to rise within 2-4 h and is
detectable in all AMI patients between
6-9 h from chest pain onset.
– It returns to baseline levels within 18-
24 h.
– Myoglobin is rapidly cleared by the
kidneys as it is small in size
– Myoglobin should not be used for early
diagnosis of AMI in patients with renal
disease because of its decreased
clearance.
 Changes in myoglobin and CK-MB

Myoglobin CK-MB
800 60
Myoglobin (ug/L)

CK-MB (ug/L)
50
600
40
400 30
20
200
10
0 0
0 4 8 12 18 24 36 48
Time after symptoms
 Cardiac Proteins
• Troponin
• Complex of 3 proteins that bind to filaments of
striated muscle (cardiac & skeletal)
– Troponin T (TnT)
– Troponin I (TnI)
– Troponin C (TnC)
• Regulate muscle contractions
• Troponin T "TnT"
– It allows for both early and late diagnosis of
AMI.
– Serum concentrations of TnT begins to rise
within a few hours of chest pain onset and peak
by day 2, a plateau lasting from 2-5 days
usually follows.
– It remains elevated beyond 7 days before
returning to reference values.
– The sensitivity of TnT for detecting AMI is 98%
from 12 h – 5 days after chest pain onset.
– It is useful for diagnosis of AMI in patients who
do not seek medical attention within 2-3 days.
• Troponin I "TnI"
– It is found in the myocardium in adults,
making it extremely specific for cardiac
disease.
– TnT tends to remain elevated longer
and maintain higher sensitivity after day
7 after infarct than TnI.
• High Sensitivity Assay for CRP ”Hs-
CRP”
– CRP is an acute-phase reactant produced
primarily by the liver.
– It is stimulated by IL-6 and increases rapidly
with inflammation.
– It rises in response to injury, infection, or other
inflammatory conditions, it is nonspecific.
– CRP may be considered as a risk factor
marker for cardiovascular disease.
– There is evidence that CRP is a reliable
predictor of acute coronary syndrome risk.
– A positive association between hs-CRP and
the prevalence of coronary artery disease.
– A mild elevation of baseline levels of hs-CRP
among apparently healthy individuals is
associated with higher long-term risk for
future cardiovascular events.
 Markers of Congestive Heart Failure
"CHF"
• Brain-type Natriuretic Peptide "BNP"
– BNP is a peptide hormone secreted primarily by the
cardiac ventricle.
– BNP acts on the renal glomerulus to stimulate urinary
excretion of Na (similar to atrial natriuretic peptide)
– Plasma concentrations of BNP are increased in
diseases characterized by an expanded fluid volume
e.g renal failure, primary aldosterodism and CHF.
– Patients with a BNP concentration < 20 pmol/L are
unlikely to have CHF and those with results above
this concentration have a high probability of CHF.
 Other markers
• Glycogen phosporylase isoenzyme BB
• Heart Fatty Acid-Binding Protein.
• Carbonic Anhydrase.
• Ischemia-Modified Albumin.
• Homocystein. (Risk Factor)