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Eastern University – Nicanor Reyes Medical Foundation o Trop T : <0.01 ng/mL or 0.01 ug/L
CD LEC LAB DX: CARDIAC MARKERS
Dra. Gacasan, MD TROP I: CRITICAL VALUE
- Troponin I: >1.5 ng/mL or > 1.5 ug/L
INTRODUCTION
- Coronary heart disease (CHD) in the form of atherosclerosis TROP I: CLINICAL IMPLICATIONS
o most important disease affecting the heart - Positive or elevated Trop I:
- Thrombotic occlusion of coronary blood flow due to CHD o Small infarcts
causes acute coronary syndrome (ACS) that may lead to o Myocardial injury during surgery
myocardial necrosis/ myocardial infarction (MI)
TROP T: CLINICAL IMPLICATIONS
PRIMARY TESTS FOR ACS DIAGNOSIS - Positive or elevated Trop T:
- Electrocardiography o Acute MI
- Laboratory measurement of cardiac markers o Perisurgical MI
- Cardiac markers are proteins released into the circulation o Unstable angina
after heart muscle damage o Myocarditis
o Non-cardiac events:
CARDIAC MARKERS § chronic renal failure;
- CK-MB § acute muscle trauma,
- Myoglobin § rhabdomyolysis,
- Troponin I (cTnI) § polymyositis,
- Troponin T (cTnT) § dermatomyositis
- Others:
o carbonic anhydrase III; CREATINE PHOSPHOKINASE (CPK); CREATINE KINASE (CK)
o Glycogen phosphorylase; - Enzyme found in
o Heart fatty acid-binding protein; o higher concentration in the heart and skeletal muscle
o Myosin; o lower concentration in the brain
o Ischemia modified albumin - Three isoenzymes:
o CK-MM (CK3) – skeletal muscles, cardiac muscles
CARDIAC TROPONIN T AND I o CK-BB (CK1) – brain, GIT, GUT
- Unique to the heart o CK-MB (CK2) – cardiac muscles
- Highly concentrated in cardiomyocytes
- High degree of cardiac specificity CPK/CK
- Release @ 1-3 hours after injury - Used in the diagnosis of MI
- Levels return to normal in 5-7 days - Reliable measure of skeletal and inflammatory muscle disease
- Preferred tests to diagnose MI - Helpful in recognizing muscle dystrophies before the clinical
manifestation
TROPONIN I - Increased in CNS disorders
- Binds to myofilaments of the troponin complex o eg. Reye‘s syndrome
- Has inhibitory character - Determination of isoenzymes helpful in making differential
- Remains increased longer than CK-MB diagnosis
- More cardiac specific - Reference values:
o Normal CPK/CK:
TROPONIN T § Men – 38-174 U/L;
- Binds to tropomyosin of the troponin complex § Women – 26-140 U/L;
- More sensitive but less specific § Infants – 2-3 times adult values
- Positive with angina @ rest o Isoenzymes:
§ MM – 96-100%;
TROPONIN T AND I § MB – 0-%; BB – 0%
- Used in early diagnosis of small MI
- Serial sampling is recommended (0, 4, 8, & 12 hours) after
chest pains
- Reference values:
o Negative (qualitative)
o Trop I : <0.12 ng/mL or <0.12 ug/L

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 CK-MB TAKE NOTE:
- Rises in 4-6 hours after MI - Values will vary depending on the testing method used.
- Not demonstrabke after 24-36 hours Always check with the laboratory for reference values.
- Interfering factors:
o Strenous exercise;
o alcohol & other drugs;
o athletes have higher levels;
o multiple IM injections;
o childbirth;
o hemolysis of blood samples

MYOGLOBIN
- The oxygen-binding protein of striated muscle
- Injury to skeletal muscle leads to release of myoglobin
- Not specific to myocardial muscle
- Rapidly excreted in urine (not tightly bound to protein)
- Used as an early marker of muscle damage in the heart and to
detect injury/necrosis of skeletal muscle
- Found earlier than CK enzymes
- Reference values:
o Normal: 5-70 ng/mL or 5-70 ug/L
- Clinical implications:
o Increased in:
§ MI,
§ angina without infarction,
§ other muscle injury;
§ toxin exposure (snake toxin),
§ renal failure,
§ electric shock,
§ malignant hyperthermia;
§ seizures
o Decreased in:
§ circulating antibodies to myoglobin;
§ rheumatoid arthritis;
§ myasthenia gravis
- Interfering factors:
o certain drugs,
o cocaine increases the level;
o renal insufficiency (decreases excretion)

Markers Time of initial Time of Peak Time to Return
Elevation Elevation to Normal

CK-MB 4-8 h 12-24 h 72-96 h

Myoglobin 2-4 h 8-10 h 24 h
Troponin I 4-6 h 12 h 3-10 d

Troponin T 4-8 h 12-48 h 7-10 d



MARKERS OF CORONARY RISK

- C-reactive protein

- Homocysteine



MARKERS OF CONGESTIVE HEART FAILURE
Notes from Lecture PPT only
- Cardiac natriuretic peptides

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