Interpretation of Cardiac Enzymes:

Certain enzymes (CPK, LDH, and SGOT) are released from the heart muscle cells hen it is in!ured ("heart attac#")$ These enzymes are normally found in the %lood at lo le&els$ The a%normal ele&ation of these enzymes in the %lood stream can occasionally %e the only indicator that a heart attac# (myocardial infarction) has occurred$ 'or heart attac#s, measurin( the le&els of cardiac enzymes in the %lood is a common test for the dia(nosis of a heart attac# and the amount the dama(e done to the heart) the medical field considers the measurement of cardiac enzyme le&els in the %lood to %e a relia%le test for a heart attac#$ Ho e&er, it is im*ortant to #no that cardiac enzymes lea# slo ly into the %lood, and unusually hi(h le&els of cardiac enzymes in the %lood may not a**ear until si+ or more hours after the onset of a heart attac#$ Thus, if a *erson has chest *ain %ut has normal le&els of cardiac enzymes in the %lood, a heart attac# cannot %e ruled out$ ,n that instance, re*eated cardiac enzymes tests are normally conducted to confirm dia(nosis of a heart attac#$ 'ollo in( are the main cardiac enzymes.$ SGOT /$ LDH (also called LD) 0$ CPK (also called CK) 1$ Tro*onin

Test: SGOT
Serum Glutamic O+aloacetic Transaminase, called- 2ST, (2s*artate 2minotransferase) 2 %lood chemistry test for the le&el of SGOT in %lood (is released ith tissue necrosis)$ 3ormal 4alues- 5617 89ml ('ran#el) 160: ,89L) or .:6:7 (Karmen) 89ml 89L at 07 de(rees C) or ;600 (S, units) at 0< de(rees C$

Clinical Implications:
This enzyme sho s an ele&ation ;6./ hours after infarction$ Pea# le&els are reached /16 1; hours after the =,$ This enzyme is not *articularly indicati&e of an =,$ Other conditions can also cause a rise in the le&els$ Hi(h le&els of SGOT may %e o%tained ith

trauma to the s#eletal muscles, in li&er disease, *ancreatitis and others$ SGOT is found inheart muscle, li&er, some also in s#eletal muscle, #idneys and the *ancreas$ Demerol and mor*hine may ele&ate the le&els tem*orarily$ This enzyme then is used ith other enzyme results to more definitely dia(nose the =,$ 2ST le&els ele&ate in :6.7 hours follo in( acute =,$ They *ea# in /1 to 1; hours$

Test: LDH, Lactic Dehydrogenase:

2n intracellular enzyme *resent in nearly all meta%olizin( cells in the %ody$ The hi(hest concentration of enzyme is located in the heart, s#eletal muscle, li&er, #idney, %rain, and erythrocytes$ There are 5 isoenzymes of LDH$ This is a %lood chemistry test to measure the amount of enzyme in the %lood$ LDH catalyzes the re&ersi%le con&ersion of muscle lactic acid into *yru&ic acid, an essential ste* in the meta%olic *rocess that ultimately *roduces cellular ener(y$ >ecause LDH is *resent in almost all %ody tissues, cellular dama(e increases total serum LDH, limitin( the dia(nostic usefulness of this test$ ,soenzymes LD. and LD/ a**ear *rimarily in the heart, red %lood cells and #idneys$ LD0 is *rimarily in the lun(s$ LD1 and LD5 are located in the li&er, s#in, and the s#eletal muscles$

Normal Values:
Total LDH- .576157 89ml (?ro%le s#i6LaDue method), :76./7 89ml (?ac#er method) <76/77 ,89L66results are different accordin( to method used$ 3e %orn- 0776.577,89L Child- 576.57 ,89L

LD.666.<$5@ to /;$0@ of total LD/66607$1@ to 0:$1@ of total LD0666.A$/@ to /1$;@ of total LD16666A$:@ to .5$:@ of total

>ecause many common diseases increase total LDH (LD) le&els, isoenzyme electro*horesis is usually necessary for dia(nosis$ ,n some disorders, total LDH may %e ithin normal limits, %ut a%normal *ro*ortions of each enzyme indicate s*ecific or(an tissue dama(e$ 'or e+am*le, in acute =,, the LD. and LD/ isoenzyme ratio is ty*ically (reater than . ithin ./ to 1; hours after onset of sym*toms (#no n as fli**ed LD)$ =idzone fractions (LD/, LD0, and LD1) can %e increased in (ranulocytic leu#emia, lym*homas, and *latelet disorders$

Clinical Implications:

The total LDH may %e influenced %y other %ody tissues, other than the heart$ Therefore, the LDH is s*lit into its fractions, isoenzymes, in order to isolate the *articular one hich is located almost solely in the myocardium$ This isoenzyme is the num%er . isoenzyme$ 2lthou(h not fool*roof, if this isoenzyme is ele&ated, it is stron(ly indicati&e of an =,$ LDH ele&ates in /161; hours and *ea#s in 1;6</ hours after the e*isode$ 3arcotic dru(s and ,= in!ections can ele&ate serum LDH le&els$ Hemolysis of the %lood can cause an ele&ated LDH %ecause LDH is *lentiful in the erythrocytes$ 2(ain, ith this enzyme, it is im*ortant to (ather a detailed *atient history$ 'ind out if there has %een in!ury to any systems hich mi(ht ele&ate the LDH le&els$ These includetrauma, cancers, leu#emia, he*atitis, shoc#, heat stro#e, sic#le cell disease$ Test: C !, Creatine hospho"inase #C!$ Creatine !inase This is a %lood chemistry test to measure the amount of enzyme in the %lood$ The CPK enzyme is found in hi(h concentration in heart and s#eletal muscle) lo concentration is %rain tissue$ CPK is an enzyme that catalyzes the creatine6creatinine meta%olic *ath ay in muscle cells and %rain tissue$ >ecause of its intimate role in ener(y *roduction, CPK reflects normal tissue cata%olism) increased serum le&els indicate trauma to cells$

Normal Values:
male- 5605 B(9ml (mc(9ml)) female- 56/5 B(9ml ne %orn- .76077 ,89L

Clinical Implications:
Serum CPK9CK ill %e ele&ated in s#eletal muscle disease, in acute =,, in cere%ral &ascular disease, &i(orous e+ercise, ,= in!ections, electrolyte im%alance, and hy*o#alemia$ CPK has three isoenzymes as *resented earlier$ 'ractionation and measurement of these three distinct CPK isoenzymes ha&e re*laced the use of total CK (or CPK) le&els to accurately localize the site of increased tissue destruction$ CK6>> is most often found in %rain tissue$ CK6== and CK6=> are found *rimarily in s#eletal and heart muscle$ ,n addition, su%units of CK6=> and CK6==, called isoforms or isoenzymes, can %e assayed to increase the testCs sensiti&ity$ These isoenzymes are.$ CK6>> (CK.) ,soenzyme D. /$ CK6=> (CK/) ,soenzyme D/ 0$ CK6== (CK0) ,soenzyme D0

?hen the isoenzyme CPK6=> is ele&ated, (reater than 5@, it could stron(ly indicate dama(e to the myocardial cells$ The CPK6=> ele&ates ithin 16: hours after an acute =,) *ea#s in .;6/1 hours) it then returns to normal ithin 061 days$ ,t is %est to a&oid ,= in!ections, e&en thou(h the in!ections ill usually not cause ele&ation of the CPK6=>$ This is %ecause other enzymes can %e affected %y the in!ections, and other enzyme studies are *erformed in con!unction ith the CPK studies$ Trauma and sur(ery ill ele&ate the CPK le&els$

Test: Troponin: The Tro*onin test is considered the most accurate cardiac enzyme
test in the dia(nosis of a heart attac#$ ,t is the most sensiti&e and s*ecific test for myocardial dama(e$ >ecause it has increased s*ecificity com*ared ith CK6=>, tro*onin is a su*erior mar#er for myocardial in!ury$

Clinical implications:
Tro*onin is the first ele&ated su%stance than any other enzymes$ ,t is released durin( =, from the cytosolic *ool of the myocytes$ ,ts su%seEuent release is *rolon(ed ith de(radation of actin and myosin filaments$ Differential dia(nosis of tro*onin ele&ation includes acute infarction, se&ere *ulmonary em%olism causin( acute ri(ht heart o&erload, heart failure, and myocarditis$ Tro*onins can also calculate infarct size %ut the *ea# must %e measured in the 0rd day$ ,t released in /F1 hours and *ersists for u* to < days$ Ho e&er, one should note that cardiac enzymes lea# slo ly into the %lood, and unusually hi(h le&els of cardiac enzymes in the %lood may not a**ear until si+ or more hours after the onset of a heart attac#$ Thus, if a *erson has chest *ain %ut has normal le&els of cardiac enzymes in the %lood, a heart attac# cannot %e ruled out$ ,n that instance, re*eated cardiac enzymes tests are normally conducted to confirm dia(nosis of a heart attac#$