Enzyme and Cardiac Markers

Enzymes when found in higher than normal concentrations in the blood may be due to

Damaged/ enflamed tissue (released from damaged cells) BUT is non specific

Different general molecules of a cardiac marker (4)

Protein, enzyme, peptide, amino acid

Cardiac markers when found in higher than normal concentrations in the blood may be due to

Cardiac cell damage (HEART ATTACK) BUT some are more specific than others

Cardiac markers are used to (2)

1. Screen for possible AMI (Heart attack)

2. Diangnose AMI (Heart attack)

Major Cardiac markers (3)

1. Troponin

2. CK-MB

3. Myoglobin

Different general molecules of a tumor marker (3)

Glycoprotein, enzyme, carbohydrate

Tumor markers when found in higher than normal concentrations in the blood may be due to

Cancer (tumor) (released from tumor) BUT may be due to other issues (NOT DIAGNOSE)

Tumor markers are used to (3)

1. Monitor tumor progression (Treatment working?)

2. Tumor staging

3. Tumor recurrence

Holoenzyme

Enzyme + cofactor (Non protein)

Non-protein component often necessary for enzyme to function

Types of Co-factors (2)

1. Inorganic

2. Organic

Inorganic cofactors (2)

• Metal ions

• Often referred to as activator

Organic cofactors (2)(2)

• Tightly Bound

  • Prosthetic group (heme, biotin)

• Loosely bound (Released after reaction)

  • Coenzyme

Coenzymes are derived from (2)

• Vitamins

• NAD, NADP

Apoenzyme

Enzyme alone (No cofactor)

AST Means

Aspartate aminotransferase

AST Increased (2)

1. Liver

2. AMI

ALT Means

Alanine aminotransferase

ALT Increased (2)

1. Liver damage

2. AMI

A Liver Transplant

ALP Means

Alkaline phosphatase

Increased ALP (4)

1. Post-hepatic liver issue

2. Bone disorders

3. Pregnancy (Placenta) (bone expansion)

4. Children (Growing bones)

GGT means

Gamma Glutamyl Transferase

GGT Increased

Alcoholism

Gin Gin Tonic

Increased Amylase and Lipase detect

• Pancreatitis

• Lipase more specific

What pancreatic enzyme rises first (2)

Amylase (2-12 hours)

Peak at 24

Lipase compared to amylase (2)

• Raises hours later (8-12)

• Higher for longer vs amylase

ACP means

Acid phosphatase

ACP Increased (2)

• Prostate damage (Tumor-cancer)

• Marker of semen

Cardiac panel (4)

1. CK-MB

2. Troponin T (cTnT)

3. Troponin I (cTnI)

4. +- Myoglobin

Most specific cardiac marker

Troponin I

I am the best!!

Creatine Kinase (CK) Different Enzymes with alternative names (3)

1. CK1 (CK BB)

2. CK2 (CK MB)

3. CK3 (CK MM)

Creatine Kinase (CK) Enzyme correlating issues

1. CK BB = CNS (Brain)

2. CK MB = AMI (Skeletal muscle damage)

3. CK MM = Skeletal muscle damage

CK Enzymes concentrations ranked

CK 3 (MM) > CK 2 (MB) > CK3 (BB)

What % of which CK indicates AMI? (2)

>6% CK 2 (MB)

Fist cardiac enzyme to increase following a heart attack

Lactate Dehydrogenase (LD or LDH) Isoforms and alternative names (5)

1. LD 1 (H4)

2. LD 2 (H3 M)

3. LD 3 (H2 M2)

4. LD 4 (H M3)

5. LD 5 (M4)

Main Locations of LD Isoforms (5)

1. LD 1 (H4) = Heart (RBC)

2. LD 2 (H3 M) = RBC (Heart)

3. LD 3 (H2 M2) = Lungs, Lymph, Spleen

4. LD 4 (H M3) = Liver, skeletal muscle

5. LD 5 (M4) = Liver, skeletal muscle

Lactate Dehydrogenase Isoforms concentrations ranked

LD2> LD1> LD3> LD4> LD5

When LD1> LD2

LD Flipped pattern = AMI

Myoglobin (Mgb) (2)

• First cardiac MARKER (protein) to increase following a heart attack

• Not cardiac specific (in skeletal muscle) BUT can rule out heart attack

BNP Means

Natriuretic peptide

BNP Incrased (2)

• CHF (Congested heart failure)

• Cardiac cell HORMONE

Homocysteine Increased (2)

• Heart disease

• Precursor to cystine → methionine

C-Reactive Protein (CRP)

1. + Acute phase

2. Inflammation → Leads to heart disease

Following AMI (1-3 hours)

Myoglobin 1st MARKER

Following AMI (3-4 hours)

CK-MB 1st ENZYME

Following AMI (3-12 hours)

Troponin

AFP (Alpha Fetal Protein) Increased

Liver cancer

CEA (Carcinoembryonic Antigen) Increased (2)

1. Colin Cancer

2. Colorectal Cancer

CEA

CA 15-3 + CA 27.29 Increased

Breast cancer

NSE Increased

Lung cancer

No Smoking Ever

CA 19-9 Increased

Pancreatic cancer

PSA Increased

Prostate cancer

CA 125 Increased

Ovarian cancer

AFP + Beta hcg Increased

Testicular cancer

NMP-22 Increased

Bladder cancer

Not My Pee

ER, PR Positive Increased (3)

ER = Estrogen

PR = Progesterone

Will likely respond to hormone therapy for breast cancer

HER2 Increased (2)

Oncogene (Cancer causing)

Will likely respond to HERCEPTIN therapy for breast cancer

BRACA1 - BRACA 2 Increased (2)

Mutated Tumor suppression gene

Increased likelyhood to develop breast cancer