Cardiac enzymes Prof. Dr. Herman Hariman, Ph.D, SpPK (KH) Prof. Dr. Adikoesoema Aman, SpPK (KH) DR. Dr. Dewi Siregar M.Ked.Clin.Path.SpPK. Cardiovascular Division, ClinPath USU Cardiac enzymes There are several enzymes that are released when heart cells are damaged. A specific, sensitive marker that is present in 1-2 hours after the cardiac muscle injury continues to be sought. CLASSICAL CARDIAC ENZYMES SGOT CPK LDH They are mitochondrial enzymes that are released during the myocardial injury They are not specific because it may be released by other muscle other than cardiac muscle e.g striated muscle ANOTHER TREND OF CARDIAC ENZYMES SGOT CK-MB LDH isoenzymes CK-MB AND LDH ISOENZYMES ARE HEART-SPECIFIC However, LDH isoenzymes availability is low in the market TROPONIN T and I Troponin T and I These are contractile proteins of the myofibril. The cardiac isoforms are very specific for cardiac injury and are not present in serum from healthy people. TROPONIN T and I Rises 2 - 6 hours after injury Peaks in 12 - 16 hours cTnI stays elevated for 5-10 days, cTnT for 5-14 days Total Creatinin Phosphokinase (CPK) ISOENZYMES MM fraction - skeletal muscle MB fraction - heart muscle BB fraction - brain CPK Creatine kinase is increased in over 90% of myocardial infarctions. It can be increased in muscle trauma physical exertion, postoperatively, convulsions, delirium tremens and other conditions. CPK begins to rise 4-6 hours peaks 24 hours returns to normal in 3-4 days So, use the isoenzyme CK-MB to give more specific result CK-MB (isoenzymes) Rises and returns to normal sooner than total CK Rises in 3-4 hours Returns to normal in 2 days *According to research from Jelita, et al (2020) it was concluded that there was no significant relationship between CK-MB and troponin I levels with the severity of acute myocardial infarction CK MB Sub-Form This test is becoming more popular. MB2 is released from heart muscle and converted in blood to MB1. A level of MB2 ≥ 1.0 U/L and an MB2/MB1 ratio ≥ 1.5 indicates myocardial infarction. MYOGLOBIN Found in striated muscle. Damage to skeletal or cardiac muscle releases myoglobin into circulation. MYOGLOBIN Rises fast (2 hours) after myocardial infarction Peaks at 6 - 8 hours Returns to normal in 20 - 36 hours Lactic Dehydrogenase (LDH) In Western Countries This enzyme is no longer used to to diagnose myocardial infarction. Due to late onset of detection following acute myocardial infarction In Medan and Indonesia in general The use of SGOT, CPK, LDH or LDH, CK-MB and Troponin T Others parameter RDW and HDL-C The RDW is one of the parameters used to diagnose and classify various types of anemias. Many studies have suggested that the RDW can also be used as a prognostic factor in various types of disorders. These include cardiovascular diseases such as myocardial infarction, and even heart failure. A high red cell distribution width (RDW), which indicates ongoing inflammation, and low levels of high-density lipoprotein-cholesterol (HDL-C) are associated with increased mortality and morbidity in patients with coronary artery disease (CAD). Recent studies have suggested that HDL-C possesses anti-inflammatory and antioxidant effects, which may explain its anti-atherogenic properties. Aman et al research (2021) results, concluded that there is a significant relationship between HDL levels and there is no significant relationship between the RDW value and the degree of coronary severity in people with coronary heart disease. AKU dan si Raja Dangdut TERIMA KASIH Terima Kasih
