CARDIAC FUNCTION TESTS In AMI

Example:
Given: LDH 1 = 6.0
Enzymes LDH 2 = 2.0 Normal formula = LDH 1 = 2 = 0.5
Creatinine Phosphokinase (CPK) LDH 2 4
Lactic Dehydrogenase (LDH) LDH 1 is increased when there is myocardial
Serum Glutamic Oxaloacetate Transaminase (SGOT) damage.
Therefore: LDH 1 > LDH 2
Acute Phase Reactants:
Troponin T (TnT) LDH 1 = 6 = 3.0
Troponin I (TnI) LDH 2 2
C reactive protein (CRP)
Therefore LDH 1 LDH 2 ratio is increased in AMI
There are three (3) isoenzymes:
CPK 1 (BB)- increased in brain abnormalities
CPK 2 (MB)- cardio-specific
CPK 3 (MM)- increased in muscular disorders

Creatinine Phosphokinase Other parameters used to detect AMI:

- Is elevated after the first 4-6 hours of AMI
- Peak is at 12 hours post AMI.
- Returns back to normal within 24 hours.
- Note: serial determination every 3-4 hours must be
done over 12 -16 hour period
Serum Glutamic Oxaloacetate Transaminase (SGOT)
- Also known as Aspartate Amino transaminase (AST).
- Is elevated after the first 12 hours of AMI
- Peak is at 24 hours post AMI.
- Returns back to normal within 48 hours.
Lactate Dehydrogenase (LDH)
- Is elevated after the first 24 hours of AMI
- Peak is at 48 hours post AMI.
- Returns back to normal within 12 days.
There are five (5) isoenzymes:
LDH 1 - cardio specific
LDH 2 - most numerous
LDH 3 - pulmonary
LDH 4
LDH 5
Troponin T - (not cardio-specific)
Troponin I - (cardio-specific)
C reactive protein (CRP)
Troponin T (TnT)
- Elevated after a few hours of chest pain
- Maybe elevated in patients with renal disease
Troponin I (TnI)
- Increased 4-8 hours after onset of chest pain
- Peaks at 12-16 hours
- Remains elevated for 5-9 days
- Values above 1.5 ng/dL is positive for AMI
- Cardiospecific
- More specific than CPK-MB
C reactive protein (CRP)
Diagnosis of Congestive Heart Failure (CHF)
B- type Natriuretic Peptide (BNP)
- definitive test for CHF
- also increased in arrhythmia and stroke
- excellent marker for early heart failure

Normal LDH 1 to LDH 2 ratio: Less than 1

Example: Normal LDH 1 LDH 2 ratio = < 1

Given: LDH 1 = 1.0
LDH 2 = 2.0

Normal formula = LDH 1 = 1 = 0.5

LDH 2 2