Cardiovascular Medicine Book

Congestive Heart Failure

Coronary Artery Disease

Hyperlipidemia

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Serum Cardiac MarkerAka: Cardiac Marker

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  1. Indications
    1. Myocardial Infarction Evaluation
  2. Best protocol for identifying AMI when EKG normal
    1. Protocol
      1. Obtain Troponin at 0 hours, 8 hours and 16 hours
        1. Primary cardiac marker: Specific for cardiac event
        2. Not useful for monitoring event extension
          1. Levels stay elevated for 14 days
      2. Obtain CK-MB at 0 hours, 8 hours, and 16 hours
        1. Primary purpose: Follow cardiac event extension
        2. Decreases more rapidly than Troponin after event
    2. Test Sensitivity of combined protocol
      1. Test Sensitivity: >98% at 8 hours
      2. Test Specificity: 80 to 95% at 8 hours
    3. References
      1. Jernberg (2000) Am J Cardiol 86:1367
  3. Troponin
    1. Rises: 3-6 hours
    2. Peaks: 20 hours
    3. Duration: 14 days
    4. Subunits
      1. Troponin T
      2. Troponin I (>1.0 suggests Acute MI)
  4. Creatine Phosphokinase (CPK)
    1. Rises: 4-6 hours
    2. Peaks: 12-24 hours
    3. Duration: 4-5 days
    4. Subunits (Fractionate to CK-MB only if CPK increased)
      1. CK-MB Fraction (duration for 2-3 days)
      2. CK-MB over 5% of total CPK suggests Myocardial Injury
  5. Myoglobin
    1. Advantage: First cardiac marker to increase
    2. Disadvantage: Poor Specificity (only helps if negative)
    3. Rises: 1-2 hours
    4. Peaks: 4-6 hours
    5. Duration: 1-2 days
  6. Glutamic oxaloacetic transaminase (AST, SGOT)
    1. Peaks: 24-36 hours
    2. Duration: 5 days
  7. Lactic Dehydrogenase (LDH)
    1. Peaks: 24-48 hours
    2. Duration: 14 days
  8. White Blood Cell Count
    1. Predicts adverse events in Unstable Angina
    2. Morbidity and mortality increase with increased WBCs
      1. WBC Count >10,000: High risk of adverse event
      2. WBC Count >15,000: Very high risk of adverse event
    3. References
      1. Cannon (2001) Am J Cardiol 87:636

Cardiac markers (C1271630)

ConceptsLaboratory Procedure (T059)
EnglishCardiac markers
Spanishdeterminacion de marcadores cardiacos
Parent ConceptsClinical Enzyme Tests (procedure) (C0014440), Duplicate concept (C1274013)
SourcesSCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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