PRESENTED BY :GROUP 5 ..

CARDIAC ENZYME

GROUP 5 i. NUR JEHAN ZAFIFI SHAHBANI ii. NURUL HAMIZAH MOHD NASIR iii. NOR ASHIKIN ABU BAKAR iv. ZUHAIRIAH ZAINAL ABIDIN v. NOR HAZWANI MD ROSLAN vi. NUR ADILAH AWATIF AZHARvii. FAEZAH KASSIM viii. NUR ZIWATULHANIS ZULKIFLI ix. NUR LIYANA AMIRUDDIN x. KHAIRUL NISHAH JOHARI xi. NOR SYAZWANI MD RAZI xii. NORLIA ABDUL WAHAB

DEFINATION

Cardiac enzyme studies measure the levels of the enzyme creatine phosphokinase ,protein troponin and myoglobin that contain in the blood .

Low levels of these enzymes and proteins are normally found in your blood, but if your heart muscle is injured, such as from a myocardial infarction the enzymes and proteins leak out of damaged heart muscle cells, and their levels in the bloodstream will rise.

WHY DO CARDIAC ENZYME TEST

SHOULD BE DONE ??

Determine whether you are having a myocardial infarction or a threatened heart attack (Crescendo angina) if you have chest pain, shortness of breath, nausea, sweating, and abnormal electrocardiography results.

Check for injury to the heart after bypass surgery.

Determine if a procedure, such as percutaneous coronary intervention (PCI), or a medicine to dissolve the blockage (thrombolytic medicine) has successfully restored blood flow through a blocked coronary artery.

WHAT ENZYMES ARE MEASURED ??

Creatine kinase (CK), the protein troponin (Tnl), and the protein myoglobin are the three that are most commonly measured.

Creatine

Kinase

CK-MM(Skelet

al Muscle)

CK-MB(Myocar

dial muscle)

CPK (Creatin

e Phosphokinase

CK-BB(Brain)

TROPONIN

(TnI) I(modulate

s the contractile

state)

C (binds

calcium)

(TnT) T(binds

Troponin I and C)

MYOGLOBIN o more rapidly released than the other two, so

readings of this protein are useful for an early diagnosis.

Elevated levels of Troponin I are as sensitive as CK-MB for the detection of myocardial injury .

Troponin I is the definitive laboratory test for diagnosis of MI .

Plasma CK-MB can be initially seen within 2 hours of symptom onset and returns to normal after 48-72 hours .

Troponin can also be seen in 2 hours after symptom onset and persists for 4 to 7 days .

Therefore blood samples should be taken immediately on admission and every 6-8 hours for the first 24 hours .

NORMAL RESULT FOR CARDIAC ENZYMES

TEST

Troponin (TnI and TnT)

Normal: TnI: Less than 0.3 micrograms per liter (mcg/L)

TnT: Less than 0.2 mcg/L

Abnormal:

Elevated troponin may be present when you have heart muscle injury. Blood levels of troponin typically rise within 4 to 6 hours after a myocardial infarct , reach their highest levels within 10 to 24 hours, and fall to normal levels within 10 days.

Total CPK (creatine phosphokinase)

Normal: Men: 38-174 international units per liter (IU/L)

Women: 26-140 IU/L

Abnormal: CPK levels generally rise within 4 to 8 hours after a heart attack, reach their highest levels within 12 to 24 hours, then return to normal within 3 to 4 days.

CPK-MB

Normal: 0% to 6% of total CPK (0.00 to 0.06)

Abnormal:

CPK-MB is found in large amounts in the heart muscle. A CPK-MB that is higher than normal may be present when you have muscle damage caused by a myocardial infarct. Blood levels of CPK-MB typically rise within 2 to 6 hours after a myocardial infarct , reach their highest levels within 12 to 24 hours, and fall to normal levels within 3 days.

An ongoing high level of CPK-MB levels after 3 days may mean that a myocardial infarct is progressing and more heart muscle is being damaged.

WHAT AFFECTS THE TEST ???

Reasons you may not be able to have the test or why the results may not be helpful include:

Other diseases, such as muscular dystrophy, certain autoimmune diseases, and Reye syndrome.

Other heart conditions, such as myocarditis and some forms of cardiomyopathy.

Emergency measures to treat heart problems, such as CPR, cardioversion, or defibrillation.

Medicines, especially injections into muscles (IM injections).

Cholesterol-lowering medicines (statins). Heavy alcohol use. Recent strenuous exercise. Kidney failure.

SUMMARY

Cardiac enzyme is a test that measures the levels of enzyme Creatine Phosphokinase , Troponin and Myoglobin .

Cardiac enzyme is done when having :o Myocardial infarct o Crescendo angina o Check for the injury to the heart after

bypass surgery o To determine whether Percutaneous

Coronary Intervention has succesfully restored blood flow through a blocked coronary artery .

Enzymes that measured is :

Creatine

Kinase

CK-MM(Skelet

al Muscle)

CK-MB(Myocar

dial muscle)

CPK (Creatin

e Phosphokinase

CK-BB(Brain)

TROPONIN

(TnI) I(modulate

s the contractile state)

C (binds

calcium)

(TnT) T(binds

Troponin I and C)

Types of test is done : o Troponin test o Creatine Kinase test o Lactate Dehydrogenase o Myoglobin o Ischemia Modified Albumin o Glycogen Phosphorylase Isoenzymes

BB Normal result : Troponin TnI - < than 0.3 mcg/L Troponin TnT - < than 0.2 mcg/L

Total CPK :o Men – 38-174 IU/Lo Women – 26-140 IU/L Factors that affects the test is : o Other disease :

Muscular dystrophy Reye’s syndrome Myocarditis

o Heavy alcohol use o Kidney failure

QUESTIONS ….

1. Berikut merupakan jenis-jenis ujian yang dilakukan dalam kardiak enzim kecuali ..

A. Troponin test B. Lactate Dehydrogenase C. Ischemia D.Aspartate Transaminase

2. Antara kenyataan berikut apakah yang dimaksudkan dengan kardiak enzim ?

A.Kajian tentang paras enzyme CPK , protein troponin dan myoglobin yang terkandung dalam darah .

B.Bertindak dengan mengubah fungsi elektrokimia di sel-sel myocardium

C.Kesakitan di bahagian dada apabila mengalami myocardial infarct .

D.Kajian tentang ujian haematologi

3. Apakah kadar normal bagi CPK-MB (creatine phosphokinese –myocardial muscle

A. 0.3 mcg/LB. 0%-11%C. 0%-6%D. 180 IU/L

4. Berikut adalah jenis-jenis protein troponin

I. TnT (Binds Troponin I dan C)II. CK-MB (myocardial muscle)III. Ck-BB (Brain)IV. TnI (Modulates the contractile

state )A.I ,II dan IIIB.I sahaja C.I dan IV D.Semua di atas

5. Apakah ujian yang sensitif dan khusus untuk mengesan myocardial infarct ?

A.Creatine Kinase (CK-MB) test

B.Troponin test C.Lactate Dehydrogenase

(LDH) test D.Myoglobin

6. Berikut adalah faktor-faktor kegagalan mendapat keputusan untuk ujian cardiac enzyme kecuali ..

A. Defibrillation B. Myocarditis C. Atherosclerosis D.Reye’s Syndrome

THE END , THANK YOU ..