By Michael W Bowers CKMB 3hr peak 1224hr lasts 13 days Troponin 312 hrs peak 1224hr lasts 821 days TropT and 714 TropI What is Creatine Kinase What is Creatine Kinase Creatine kinase is an enzyme ID: 606078
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Slide1
Cardiac Enzymes
By Michael W. BowersSlide2
CK-MB
3hr, peak 12-24hr lasts 1-3 days
Troponin 3-12 hrs, peak 12-24hr, lasts 8-21 days Trop-T and 7-14 Trop-I Slide3
What is Creatine Kinase?Slide4
What is Creatine Kinase?
Creatine kinase is an enzyme
CK catalyses the conversion of creatine
Uses ATP to create phosphocreatine (
PCr
) and ADP.
This CK enzyme reaction is reversible, such that also ATP can be generated from
PCr and ADP. PCr serves as an energy reservoir for the rapid buffering and regeneration of ATP in situ and for intracellular energy transportSlide5
Where,
O
h Where, is Creatine Kinase MB Isoenzyme?
WillSlide6
Where, Oh Where, is Creatine Kinase MB Isoenzyme?
Myocardium
1-2% inSkeletal MuscleTongue
Small intestine
DiaphragmSlide7
What Causes Creatine Kinase Levels to Rise? Slide8
What Causes Creatine Kinase Levels to Rise?
M
yocardial infarction
Cardioversion
Cardiac Surgery
PCI
Hello Cath Lab!
Rapid TachycardiaHypothyroidismExtensive TraumaRhabdomyolysis (severe muscle breakdown)Muscular dystrophy
Myopericarditis
Recent
cocaine useSlide9
OK Kids, Let’s Talk TroponinSlide10
Troponin
Troponin is a complex of three regulatory proteins
Troponin C, troponin I and troponin TIntegral to muscle contraction in skeletal and cardiac muscle, but not smooth muscle More Cardiac Sensitive and Specific than CK-MBSlide11
TroponinSlide12
Troponin
Released during MI from myocytes
Heart Muscle Breaks Down Its subsequent release is prolonged with degradation of actin and myosin filaments It released in 2–4 hours and persists for up to 7 days.Slide13
Diff DX of Elevated Troponin
Acute infarction,
Renal failure
Severe pulmonary embolism causing acute right heart overload
Heart failure
Myocarditis.
Tachy-
or bradyarrhythmias, or heart blockHypertrophic cardiomyopathyCardiac contusion or other trauma including surgery, ablation, pacing, implantable cardioverter-defibrillator shocks, cardioversion, endomyocardial biopsy, cardiac surgery, following interventional closure of atrial septal defects
Aortic dissection
Aortic valve disease
Apical ballooning syndrome -
Takotsubo
Cardiomyopathy
Rhabdomyolysis with cardiac injury
Critically ill patients,
especially
with diabetes, respiratory failure or sepsis
Acute
neurological
disease
stroke or subarachnoid hemorrhage
Infiltrative
diseases
amyloidosis
, hemochromatosis, sarcoidosis, and
scleroderma
Inflammatory diseases
myocarditis
or myocardial extension of endo-/pericarditis, Kawasaki
disease
Burns
, especially if affecting >25 percent of body surface area
Extreme
exertionSlide14
Timing
Cardiac enzymes leak slowly into the blood
High levels of cardiac enzymes may take six or more hours after the onset of a heart attackPt with chest pain but normal levels of cardiac enzymes = a heart attack cannot be ruled outRepeated cardiac enzymes tests are normally conducted to confirm diagnosis of a heart attackSlide15
CK-MB
3hr, peak 12-24hr lasts 1-3 days
Troponin 3-12 hrs, peak 12-24hr, lasts 8-21 days Trop-T and 7-14 Trop-I Slide16
Hurst’s The Heart
Up
to date
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