Cardiac Markers
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| Historically the clinical diagnosis of an acute MI requires two of what three findings | Chest pain, Characteristic EKG changes, and increased serum enzymes
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| Diseases affecting cardiac muscle cause an increase in what CK enzymes | CK MM and MB (MI, Trauma to the heart)
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| Disorders affecting the skeletal muscle cause an increase in what CK enzymes | CK MM (Dystrophies, trauma, Hypothyroid, stroke, psychoisis)
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| Diseases affecting smooth muscle cause and increase in what CK enzymes | Increased CKBB (labor and delivery, Intestinal infarct, shock)
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| How long after the onset of symptoms (of MI) do CK and CKMB become abnormal | 8 hours (peak within 36 hours)
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| when do CK enzymes return to normal after a MI | within 2-3 days
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| what is the most sensitive and specific marker for a MI | Cardiac troponin I and T
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| When do cardiac troponins increase after symptoms of an MI | about 8 hours after symptoms
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| how long do troponins remain increased after a MI | 7-10 days (continued release not delayed clearance)
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| When do CK markers prove more useful than troponins | when you need to detect re-infarct in the acute >3 <10 day period following a MI
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| How specific are troponins for coronary artery etiologies of myocardial infarction | they are not specific for coronary artery etiologies of myocardial disease they are increased in cardiac conditions that are associated with myocardial injury such as heart failure and cardiomyopathies
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| when are natriuretic peptides A and B increased | in serum in chronic heart failure secondary to enhanced atrial and ventricular synthesis
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| where are B-type natriuretic peptides found | in the brain and ventricles of the heart (released in response to ventricular overload)
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| where are c-type natriuretic peptides found | in the brain and CNS released in response to endothelial stress
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| When is BNP used | in diagnosis of heart failure in ED patients, Monitoring therapy of heart failure, prognosis in acute coronary syndromes
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| Where is CRP produced | in the liver
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| when is CRP increased | with inflammation (used as a nonspecific test for infection)
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| How can CRP be used to assess risk of MI | atherosclerosis increases CRP
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