Tietze Chapter 5 (Cardiovasular)

40-150 units/L

Creatinine Kinase Female Values

60-400 units/L

Creatinine Kinase Male Values

0-7 ng/mL

CK-MB RR

0.08-3.1 mg/L

C-reactive protein RR

100 to 190 units/L

Lactic Dehydrogenase LDH RR

Cardiac Enzymes

The pattern and time course of the appearance of enzymes in the blood after cardiac muscle cell damage are used to diagnose myocardial infarction

CK-MB Fraction

It is detectable in the blood within 3 to 5 hours after a myocardial infarction; levels peak at about 10 to 20 hours and normalize within about 3 days.

• low-density lipoprotein (LDL)

• high-density lipoprotein (HDL)

Cholesterol is separated into lipoproteins by protein electrophoresis. The level of — is strongly correlated with coronary artery disease. The level of — is inversely correlated with coronary artery disease.

<200 mg/dL

Lipids

• Cholesterol, total RR

<160 mg/dL

Lipids

• Triglycerides, fasting RR

C-reactive protein (CRP)

— is a biologic marker of systemic inflammation. Preliminary studies have linked an increased concentration of this to an increased risk of myocardial infarction, stroke, and peripheral arterial disease.

• HBE Heart, Brain Erythrocytes

• Brain, Kidney

• Liver, SM, Kidney

• Liver, SM, Ileum

LDH Locations

• LDH1 and LDH2

• LDH 3

• LDH4

• LDH5

• 14-26%

• 29-39%

• 20-26%

• 8-16%

• 6-16%

LDH RR

• LDH1

• LDH2

• LDH3

• LDH4

• LDH5

LDH2

What LDH isoenzyme normally accounts for the highest percentage of total serum LDH

• 12 hours

• 24-47 hours

• Day 10

LDH increases within about — after a myocardial infarction, peaks between —, and normalizes by about —

Myoglobin

It is a small protein found in cardiac and skeletal muscle. The presence of it in the urine or plasma is a relatively sensitive indicator of cellular damage.

Triglycerides (TGs)

— are components of very-low-density lipoproteins (VLDLs) and chylomicrons.

Troponin I and T

They are a complex of proteins (troponin I, C, and T) that mediate the actin and myosin interaction in muscle. Troponins I and T are specific to cardiac muscle and are used to detect cardiac muscle injury.

5 to 7 days

Troponin I and T concentrations increase within a few hours of cardiac muscle injury and remain elevated for —.

0-0.4 ng/mL

Troponin I RR

0-0.1 ng/mL

Troponin T RR

CK-MB (CK2)

What CK is found in cardiac tissue

CK-MB

It is important marker in the diagnosis of acute myocardial infarction(AMI).

Troponin I

This troponin is found in the cardiac muscle

Troponin T

This troponin is found in the cardiac and skeletal muscle

Troponin T and I

These ae sensitive markers of cardiac injury

• Levels begin to rise within 4 hours of onset of chest pain.

• Levels should be drawn on admission and within 8 to 12 hours

• Patients with elevated levels are considered at high risk for a significant cardiac event.

• coronary heart disease (CHD)

• Elevated total serum cholesterol is well known to be associated with an increased risk of developing —

Triglycerides

They are the main storage form of fatty acids, and they account for greater than 90% of dietary fat intake.

Triglycerides

Decreased — is associated with malnutrition and brain infarction

• 2000 mg/dL

• When triglycerides are greater than — it may cause xanthomas on the elbows, knees, and buttocks.