PRIMARY CARDIAC BIOMARKERS HOURS Enzyme starts to rise peaks

**Used to support the diagnosis of myocardial muscle injury (infarction). **Can also indicate neurologic or skeletal muscle diseases. **CK is found predominantly in the heart muscle, skeletal muscle, and brain. Serum CK levels are elevated when these muscle or nerve cells are injured Creatine Kinase-Myocardial Band Indicates tissue necrosis. CK is overall, MB specific to myocardium **can quantifying the degree of MI & timing the onset of infarction **often used to determine the appropriateness of thrombolytic therapy. **High levels may indicate that significant infarction has already occurred, thus precluding a benefit from thrombolytic therapy. Elevated levels of this enzyme may indicate cardiac injury. It is not specific to the heart, however.

DAYS returns to normal

values

Total CK

6hrs

18hrs

2-3days

Male: 55-170 units/L Female: 30-135 units/L

CK-MB

3-12hrs

12-24hrs

5-10days

Isoenzyme CK-MB 0%

DO NOT usually rise with transient chest pain caused by angina, pulmonary embolism, or congestive heart failure. WILL RISE in patients with shock, malignant hyperthermia, myopathies, or myocarditis. Mild elevation in patients with unstable angina and will signify an increased risk for an occlusive event.

AST

8hrs

24-36hrs

3-7days

0-35 units/L

Found in very high concentrations w/in highly metabolic tissue, -->heart muscle, liver cells, skeletal muscle cells, and to a lesser degree in the kidneys, pancreas, and RBCs. When disease or injury affects the cells of these tissues, the cells lyse. The AST is released, picked up by the blood, and the serum level rises. The amount of AST elevation is directly r/t the number of cells affected by the disease or injury.

This intracellular enzyme is used to support the diagnosis of injury or disease involving the heart, liver, red blood cells, kidneys, skeletal muscle, brain, and lungs. rise quickly, not found in healthy pt, low swnsitivity in <6hrs. **performed on pts with chest pain to determine if the pain is caused by cardiac ischemia. **Also helpful in predicting the possibility of future cardiac events. rise quickly, not found in healthy pt, low sensitivity <6hrs. **performed on pts with chest pain to determine if the pain is caused by cardiac ischemia. **Also helpful in predicting the possibility of future cardiac events. **used in the early evaluation of a patient with suspected acute MI **found in skeletal & cardiac Brain natriuretic peptide cardiac neurohormone released in response to ventricular volume overload

LDH

24-48hrs

2-3days

5-10days

Total LDH 100-190 units/L LDH-1: 17% to 27% Isolated elevation of LDH-1 (above LDH2) indicates myocardial injury.

Troponin T

3-12hrs

24hrs

10-14days

<0.2 ng/ml

Troponin I

3-12hrs

24hrs

4-7days

<0.03 ng/ml

Myoglobin

1-4hrs

6-7hrs

24hrs or 1 day

<90 mcg/L
BNP is the cardiac ventricle. Coorelates to LV pressures. BNP is released in response to atrial and ventricular stretch, respectively, and will cause vasorelaxation, inhibition of aldosterone secretion from the adrenal gland and renin from the kidney, thereby increasing natriuresis and reduction in blood volume.

BNP

<100 pg/mL