TROPONIN, CREATININE, MYOGLOBIN, LDH,

1. CARDIAC
BIOMARKERS
LABORATORY
INTERPRETATION
PREPARED BY: PHARM-D 5TH YEAR
PROFESSIONALS

2. TOPIC
CARDIAC BIOMARKERS
TROPONIN
Prepared by :
MAHA KIRAN

3. • Substances that release into the bloodstream when the
heart is damaged or stressed
• Measure to evaluate heart function
• Early developed for acute MI
Currently, useful to diagnose :
 Cardiac ischemia
 Acute Coronary syndrome
CARDIAC BIOMARKERS

5. TYPES OF CARDIAC BIOMARKERS
Four established biomarkers for
myocardial necrosis:
• Cardiac Troponin I &T
• Creatine Kinase
• Myoglobin
• LDH

6. • Contractile proteins found in muscle that play role in
actin-myosin interaction
• Found in all muscle
• Exist In Three Isoforms:
• Troponin C, (TnC)
• Troponin I, (TnI)
• Troponin T. (TnT)
• (TnI) & (TnT) both are specific for cardiac muscle
TROPONIN

7. CARDIAC TROPONIN
• Rising in the blood 4-6 hours post
infarction
• Peaks in 12-24 hours
• Come to baseline within 10-14 days
Range
• Normal individual :<0.001ng/ml
• Acute coronary syndromes,
• Troponin range:Equal /> 0.001ng/ml

8. TOPIC
CREATINIE KINASE
Prepared by :
MAHAM UROOJ

9. CREATINIE KINASE
• Also known as creatine phosphokinase (CPK) or
phosphocreatine kinase.
• Found in cells of heart, skeletal muscles and brain.
• A test to know the concentration of CPK in serum.
• Responsible for the generation of energy in
contractile muscular tissues.
• Mainly useful in detecting damage to myocardial
and skeletal muscle tissue.

10. Contd….
• Therefore CK estimation is very useful to detect early
cases.
• CK level is not raised in hemolysis or in congestive
heart faliure; and therefore CK has an advantage over
LDH.
• CK levels are changed in disorder of cardiac and
skeletal muscle.

11. FUNCTION OF CK
• Creatine kinase (CK ) transfer phosphate from ATP to creatine
forming creatine phosphate and ADP.
• This reaction is reversible.
• Phosphocreatine is regenerated when ATP is abundant.
• Provide rapid regeneration of ATP when it is low.
• Enzyme used in synthesis and use of energy providing
molecules.

12. TOPIC
CREATINIE KINASE
Prepared by :
MAHAM FAYYAZ

13. SUB-UNIT OF CREATINE KINASE
• 2 sub-unit of Creatine Kinase
 B
 M
ISOENZYMES OF CREATINE KINASE
3 isoenzymes of CK
 CK-1 (CK-BB)
 CK-2 (CK-MB)
 CK-3 (CK-MM)

14. Normal Range
 55-170 units/L for men
 30-135 units/L for women
 60-580 units/L for newborn

15. LOW LEVEL OF CK IN BLOOD
 Rare
 Not a abnormality
Drugs That Increase CK Measurement Include:
 Amphotericin B
 Statins
 Alcohol
 Cocaine

16. FACTORS THAT MAY AFFECT THE TEST
RESULTS INCLUDE:
 Trauma muscles
 Recent surgery
 Heavy Exercise
 Drinking too much alcohol

17. TOPIC
MYOGLOBIN
Prepared by :
JAVERIA SIDDIQUI

18. MYOGLOBIN
• Myoglobin has been used as a marker of
myocardial damage.It is commonly used in
clinical practice as an early marker of AMI
However, due to the high concentration of
myoglobin in skeletal muscle tissues,increases
the myoglobin levels in blood.

19. Cont…
• Small size heme protein find in all tissues maily
assists in oxygen transport.
• It is released from all damaged tissue.
• Increases often occur more rapidly than TI and CK
• Cannot be used alone to confirm MI
• Realeased from damaged tissue within one hour.
• Normal value=(17.4-105.7ng/mi)

20. CONDITIONS FOR INCREASE MYOGLOBIN
• Acute myocardial infarction
• Renal failure
• Shock and trauma
• Skeletal muscle damage
• Muscular dystrophy
• Inflammatory myopathies

21. CLINICAL USEFULNESS
• Rapid monitor of success of thrombolytic therapy
• Negative predictor of MI

22. DRAWBACKS
• Due to poor specificity myoglobin levels do not
always predict myocardial injury.
• Not utilized often for AMI/cardiac damage
assessment because of its very rapid metabolism

23. TOPIC
LACTATE DEHYDROGENASE
(LDH)
Prepared by :
MARIAAKRAM

24. LACTATE DEHYDROGENASE (LDH)
 It is an enzyme required during the process of Cellular
respiration.This enzyme turns sugar into energy.
 LDH is present in the liver, heart, pancreas, kidneys, skeletal
muscles, lymph tissue, and blood cells.
CAUSES
 When illness or injury damages your cells, LDH may be
released into the bloodstream, causing the level of LDH in
your blood to rise. High levels of LDH in the blood point to
acute or chronic cell damage, but additional tests are necessary
to discover its cause. Abnormally low LDH levels only rarely
occur and usually aren’t considered harmful.

25. NORMAL RANGES
Newborns -- 160-450 units per liter (U/L)
Infants -- 100-250 U/L
Children -- 60-170 U/L
Adults -- 100-190 U/L

26. Normal results for isoenzymes are listed below.
Adult/older adults:
 LDH-1: 17% to 27%
 LDH-2: 27% to 37%
 LDH-3: 18% to 25%
 LDH-4: 3% to 8%
 LDH-5: 0% to 5%
Normal ratios are:
 LDH-1 less than LDH-2
 LDH-5 less than LDH-4

27. ABNORMAL RESULTS
 Increased levels of LDH1 are seen in myocardial infarction, red b
lood cell diseases like hemolyticanemia, kidney disease including
kidney transplantation rejection, and testicular tumors.
 Increased levels of LDH2 are found in lungdiseases such as pneu
monia and congestive heart failure, as well as in lymphomas and
other tumors.
 Elevations of LDH3 are significant in lung disease and certain tu
mors. Elevations of LDH4 are greatly increased in pancreatitis.
 Highlevels of LDH5 are found in liver disease, intestinal problem
s, and skeletal muscle disease and injury, such as muscular
dystrophy and recent muscular trauma.

28. TOPIC
LACTATE DEHYDROGENASE
Prepared by :
HAREEM KHALID

29. WHAT CAUSES HIGH LDH LEVELS?
 Blood flow deficiency
 Cerebrovascular accident also known as a stroke
 Certain cancers
 Heart attack
 Hemolytic anemia
 Liver disease, such as hepatitis
 Muscle injury
 Muscular dystrophy
 pancreatitis
 Tissue death
 Use of alcohol or certain drugs
 Sepsis & septic shock

30. LOW LDH LEVELS
 It’s very rare for a person to have low LDH levels.
 Two types of genetic mutations cause low LDH levels.
In first type Symptoms are
 fatigue
 muscle pain
In second type
 no symptoms at all.
You may also have low LDH levels if you’ve consumed a large
amount of ascorbic acid (vitamin C).
How is this test done?
 The test is done with a blood sample. A needle is used to draw
blood from a vein in your arm or hand.

31. CLINICAL SIGNIFICANCE
 The lactate dehydrogenase (LDH) may be used as a
general indicator for the severity of acute and chronic
tissue damage.
 LDH may be used to detect and monitor progressive
conditions such as anemia including hemolytic
anemia and severe infections.
 LDH determine prognosis or monitor treatment i.e
chemotherapy of cancer such as germ cell tumors e.g
testicular and ovarian cancer, lymphoma, leukimia
and neuroblastoma.

32. PRECAUTION
 Certain medications and drugs may interfere with an
accurate LDH test.
 Large amounts of vitamin-C (ascorbic acid) may
lower LDH levels.
 Alcohol, anesthetics, aspirin, narcotics, and
procainamide may raise LDH levels.
 Strenuous exercise may also raise LDH levels.