II Cardiac

II Cardiac - II LABORATORYDIAGNOSIS OFCARDIACDISEASE

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II  LABORATORY DIAGNOSIS  OF CARDIAC DISEASE Laboratory Medicine (SPPS 216)
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Surgery for heart may be overused Drugs called just as effective as stents in  nonemergency  UNION-TRIBUNE NEWS SERVICES  March 27, 2007  NEW ORLEANS – More than half a million  people a year with chest pain are getting an  unnecessary or premature procedure to unclog  their arteries because drugs are just as effective,  suggests a landmark study that challenges one of  the most common practices in heart care. 
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OBJECTIVES To understand the role of the laboratory in  the diagnosis of acute myocardial infarction To understand the time frame in which  various protein markers of cardiac damage  should be monitored To understand the differences in the various  cardiac markers in terms of sensitivity and  specificity To understand the role of the laboratory in  the diagnosis and monitoring of heart failure 
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KEY TERMS  Acute Myocardial  Infarction (AMI) Acute Coronary  Syndrome (ACS) Cardiac Markers Cardiac Troponin T  (cTnT) Cardiac Troponin I  (cTnI) Heart Failure Creatine Kinase  (CK) Creatine Kinase MB  (CKMB) Dypsnea Isoenzyme Myoglobin Natriuretic Peptides
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BACKGROUND/SIGNIFICANCE  6 million/year present to ER complaining  of chest pain 4 million admitted for workup of AMI 1.5 million people rule in (have an AMI)  11,000 discharged with an undiagnosed  AMI 
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Spectrum of Disease Health Death Stable  Angina Unstable  Angina STEMI Non-STEMI Q wave
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WHO definition of AMI Chest Pain ECG Biomarkers 1/3 have atypical CP 50% non diagnostic 2/3 = AMI Rise and fall
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Current Definition of MI Rise and fall of cTn (or CKMB) with at  least one of the following: Ischemic symptoms Q waves ECG changes (  or  ST segment) Coronary artery intervention (e.g. angioplasty) Pathological findings of AMI
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Ischemic Injury Loss of cellular respiration No energy source Loss of membrane integrity Macromolecules leak
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Important factors in Real Estate Location, Location, Location Size Uniqueness
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Cardiac Markers Marker Reference Range Cardiac troponin I (cTnI) < 0.07 ng/mL * Cardiac troponin T (cTnT) < 0.1 ng/mL * Creatine kinase MB isoenzyme (CKMB) < 10 ng/mL Myoglobin < 170 ng/mL (> 25% increase over 90 min. suggests AMI) * As assays become more sensitive and specific the reference range for troponins continues to decrease.
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Biomarker Kinetics Biomarker Kinetics
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Protein Elevations in Serum after MI Time After Infarction Serum Protein 1st Elevation (hours) Peak Elevation (hours) Duration of Elevation (days) CK 4-6 18-36 3 (~2-3× normal only) Myoglobin 2-3 6-9 1 Troponin I & T 4-6 24-36 depends on extent of damage
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Structure of Troponin Complex
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II Cardiac - II LABORATORYDIAGNOSIS OFCARDIACDISEASE

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