CARDIAC ENZYMES

(BIOMARKERS)
Cardiac Enzymes (Cardiac Biomarkers)
- When there is a heart damage or stress due to low oxygen, your heart releases
CARDIAC ENZYMES in bloodstream.

- Troponin & creatinine phosphokinase (CPK) levels rise after heart attack.

- Cardiac markers are the biomarkers that measures to evaluate heart function.

- Not all of the markers currently used are enzymes, for example, “TROPONIN”.
Purpose of Cardiac Biomarkers

Physician measures cardiac marker levels to:

- Screen for heart damage & other problems

- Diagnose heart conditions that cause symptoms such as chest pain, angina &
shortness of breath.

- Monitor how well heart medication & heart surgery works.

Applications & Measurements

- Measuring cardiac biomarkers can be a step towards diagnosis.

Cardiac Imaging
- It can be an initial testing strategy when patient is at low risk of cardiac death.
Cardiac Troponin

Most commonly used biomarker, it has highest non sensitivity, and it enters to
your blood stream soon after your heart attack.
It also stays in your blood stream when other biomarkers go back to their
original level.
Two forms of troponin may be measured,
- Troponin T
- Troponin I
Creatinine kinases CK

This enzyme can also be measured several times over 24 hours it will often at
least double if you have had a heart attack, but because levels of CK go up in
many other conditions besides heart attack. It is very specific.

Creatine kinase also known as creatine phosphokinase, CPK is a muscle enzyme

that exists as isoenzymes. The CK level increases approximately 3 to 4 hours
after Myocardial Infractions and remains elevated for 3 to 4 days.
CK-MB

This is sub type of CK,

-It is more sensitive for finding heart damage, from a heart attack.
- CK-MB rises 4-6 hours after heart attack, but it is generally back to normal in a
day or two.
- Because of this its not helpful when a physician is trying to figure out if your
recent chest pain was a heart attack.
Myoglobin

The benefit in myoglobin is that a detectable increase is seen only 30 minutes

after injury occurs, unlike in troponin and creatine kinase, which can take
between 3 and 4 hours.
This is a small protein that stores oxygen,
Myoglobin is sometime measured in addition to troponin to diagnose heart
attack.
It is also not specific for finding heart attack.
Other BioMarker Tests

hs-CRP-this test may be used to determine risk of future heart attack & test in
people who already suffered one in past.

BNP (or NT-proBNP)-although usually used to recognize heart failure, and

increase level in people with ACS indicates and increase risk recurrent events.