BCHS-4361-09-CK--TR_38186

BCHS-4361-09-CK-TR_ - CREATINE KINASE AND TROPOININ ISOZYMES IN DIAGNOSIS OF MYOCARDIAL INFARCTION • The aim of this topic is to illustrate the

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Unformatted text preview: CREATINE KINASE AND TROPOININ ISOZYMES IN DIAGNOSIS OF MYOCARDIAL INFARCTION • The aim of this topic is to illustrate the utility of protein isoforms in diagnosis of a pathological state. • Creatine kinase, an enzyme and, more recently, troponin, a muscle protein, have been of value in diagnosing an acute myocardial infarction (AMI). • Their reliability as indicators of an AMI is based on the release of specific isoforms from damaged heart muscle. Myocardial infarction • Acute myocardial infarction is the rapid development of myocardial necrosis caused by a critical imbalance between the oxygen supply and demand of the myocardium. • AMIs cause 500,000-700,000 • deaths in the US annually. • Acute coronary syndrome : condition of unstable ischemic heart disease, usually arising from coronary artery obstruction. Myocardial infarction • Symptoms – Angina pectoralis – Dyspnea (shortness of breath) – Nausea and/or abdominal pain – Anxiety – Lightheadedness and syncope (transient loss of consciousness and posture) – Cough – Nausea and vomiting – Diaphoresis (excessive sweating) • One problem - Differential diagnosis – Pericarditis (inflammation of sac surrounding heart) – Aortic Dissection (tear or damage to aortic wall) – Cholecystitis and Cholelithiasis (gallstones) – Laryngeal spasm – Anxiety attack – and on and on and on… • One diagnostic solution – “Cardiac enzymes” ONSET OF AMI • AMI refers to irreversible necrosis of myocardium. It usually results from thrombosis where there is a vessel wall injury or pre-existing plaque in a major coronary artery. • Risk Factors Smoking Hypertension Diabetes Mellitus Diet Family history Stress Sedentary lifestyle ATHEROSCLEROSIS: The Road to Thrombus Formation • Physiology – Sub intimal accumulation of lipids – Invasion by fibrous tissue and subsequent plaque formation – Calcification • Most common sites – Proximal coronary arteries – Bifurcation of blood vessels • Risk Factors Elevated low density lipoproteins (LDL) and triglycerides Serum high density lipoproteins (HDL) levels – inversely related to risk PATHOGENESIS OF ATHEROSCLEROSIS • Chronic inflammatory response of the vascular wall to endothelial injury or dysfunction • Elevated plasma LDL levels causing the deposit of LDL in the subendothelium of blood vessels • Oxidation of transmigrated LDL • Activation of endothelial cells • Recruitment of monocytes/macrophages which ingest oxLDL through scavenger receptors • Formation of foam cells – fatty streaks • Proliferation of smooth muscle cells • Deposition of extracellular matrix proteins Normal Artery MAJOR COMPONENTS OF PLAQUE...
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This note was uploaded on 01/23/2011 for the course BCHS 4361 taught by Professor Echberg during the Spring '09 term at University of Houston.

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BCHS-4361-09-CK-TR_ - CREATINE KINASE AND TROPOININ ISOZYMES IN DIAGNOSIS OF MYOCARDIAL INFARCTION • The aim of this topic is to illustrate the

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