TES LABORATORIUM

PENYAKIT
KARDIOVASKULAR

Ingrid Hutagalung
Abnormalities in Clinical Chemistry
Cardiac Function Tests

MI and ACS
Acute MI (AMI) requires rapid and accurate diagnosis
clinical Lab. provide serum diagnostic test diagnosis
at an early stages.

Myoglobin (MY) :
oxygen binding/transport protein found in cardiac and skeletal
muscle
Early release from irreversible damaged cells
Current methods for measurement cannot distinguish
Screening patients for possible AMI
Abnormalities in Clinical Chemistry
Cardiac Function Tests

MI and ACS
Troponin regulatory protein complexes in muscle tissue;
comprises 3 sub unit : TnI, TnT, TnC sens. and spec.
>90 % and elevated 12hs after onset sens. 100%.

TnI :
in skeletal and cardiac muscle
contain 31 amino acid in his N-terminal
Elevated 4-8hs after onset of chest pain
reaches a peak at 12-16 hs
remain elevated for 5-9 days
more specific for cardiac injury
Abnormalities in Clinical Chemistry
Cardiac Function Tests

MI and ACS
TnT :
have no tissue specific sequence differences
Elevated 4-8hs after onset of chest pain
reaches a peak at 12-16 hs
remain elevated for 5-9 days
effective and specific for cardiac injury
maybe elevated in renal disease
Abnormalities in Clinical Chemistry
Cardiac Function Tests

MI and ACS
CK-MB :
isoenzyme of creatinine phosphokinase (CK)
predominantly found in cardiac musle
Serial determinations of MB fraction necessary
sens. 100%
Elevated 3-4hs after onset of chest pain
reaches a peak at 12-16 hs
Abnormalities in Clinical Chemistry
Cardiac Function Tests

CHF
Diagnosed basis of symptomatology and as a result of
echocardiography.

New biomarker B-type Natriuretic Peptide (BNP) :

approved as a definitive test
an excellent marker for early heart failure
for diagnostically and prognostically significant in patients
presenting acute dyspnea and chest pain
may also be an independent predictor of arrythmia, stroke and
death.
Abnormalities in Clinical Chemistry
Markers for Inflammatory Conditions

Increases in WBC, esp. neutrophils acute infection.

Acute phase reactan proteins also increases alpha

(alpha-1-antitrypsin, alpha-2-macroglobulin) and beta
(ferritin and C-reactive protein).

Specific antibodies to CRP = hsCRP higly sensitive

elevated level cardiovascular risk for stroke and MI.

Fibrinogen as acute phase reactant also increase.

Increase in the ESR.