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Cardiac Function Test 2018

Cardiac function tests measure biomarkers in the blood to detect damage to cardiac tissue and help diagnose cardiac diseases like myocardial infarction. Key tests include creatine kinase (CK), CK-MB, lactate dehydrogenase (LDH), aspartate transaminase (AST), cardiac troponins I and T, myoglobin, and a lipid profile measuring cholesterol, triglycerides, HDL, LDL, and VLDL levels. These tests are important for diagnosing cardiac issues and monitoring recovery from events like a heart attack.

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Chandana Padma Priya Jutur
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48 views

Cardiac Function Test 2018

Cardiac function tests measure biomarkers in the blood to detect damage to cardiac tissue and help diagnose cardiac diseases like myocardial infarction. Key tests include creatine kinase (CK), CK-MB, lactate dehydrogenase (LDH), aspartate transaminase (AST), cardiac troponins I and T, myoglobin, and a lipid profile measuring cholesterol, triglycerides, HDL, LDL, and VLDL levels. These tests are important for diagnosing cardiac issues and monitoring recovery from events like a heart attack.

Uploaded by

Chandana Padma Priya Jutur
Copyright
© © All Rights Reserved
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Cardiac function

test

By : zalak , jemisha , namrta , priyanka , kalyani ,


dipika
Introduction
o Cardiac function tests used to determine whether
there has been any cardiac tissue damage.
o This tests performed to help diagnose a cardiac
disease.
o Myocardial infarction
o Coronary artery disease
o Atherosclerosis
Cardiac function tests include
1. CK (Creatine kinase)
2. CK-MB
3. LDH (Lactate Dehydrogenase)
4. SGOT
5. Troponin
6. Myoglobin
7. Lipid Profile :
1. Cholesterol
2. Triglyceride
3. HDL-cholesterol
4. LDL-cholesterol
5. VLDL-cholesterol
8. LDL/HDL ratio
9. LDL/Total cholesterol
10. Apolipoprotein – A1
11. Apolipoprotein - B
1. CK (CREATINE KINASE)
Principle:
Method : Increasing Kinetic
Biological reference range :- 25-120 U/L
Clinical Significance:
CPK ( Creatine phosphokinase ) activity is increase in
 Brain (CK-BB = 1%)
 Cerebro-vascular stroke
 heart muscle (CK-MB = 5-10%)
 Myocardial infarction
 Acute coroary syndrome
 skeletal muscle. (CK-MM= 85%)
 Crush injury
 Myopathy
 Polymyositis
2. CK-MB
Principle:
measurement of CK activity in the presence of an antibody to
CK-M monomer.
This antibody completely inhibits the activity of CK-MM & half
of the activity of CK-MB while not affecting the B subunit activity
of CK-MB &CK-BB.

Method :
•Increasing Kinetic UV method
Biological reference range :-0 - 25 IU/L
Significance:
•CK-MB present only in cardiac tissue
•So…Specific for diagnosis of cardiac disease
CK-2 & CK-3 in normal subject &
After 24 hours of Myocardial Infarction
Creatine Kinase isoenzymes in blood
3. LDH (lactate dehydrogenase)
Principle:
 Lactate dehydrogenase catalyses the conversion of pyruvate
to lactate.

Lactate dehydrogenase

Lactate + NAD+ ---------------- Pyruvate + NADH + H+

The rate of NADH+ formation is measured by 340nm filter.


It is direactly propotional to serum LDH activity.
Method :
•IFCC method (Lactate to Pyruvate method )
•Increasing kinetic
Biological reference range :- 70-240 IU/L
Clinical significance :
RBC
 Malaria
 Sickle cell anemia
 hemolytic disorder
Liver
 Viral Hepatitis
 Liver malgnancy
 Alcoholic liver disease
Cardiac tissue
 Myocardial infarction
Skeletal muscle
 Muscular distrophy
 Crush injury
LDH Iso-enzyme
4. GOT ( AST )
Principle:
L-Aspartate+α KetoglutarateGOT(with P5P) Oxaloacetate + LGlutamate

MDH
Oxaloacetate + NADH + H+ Malate + NAD+

AST = Aspartate Transaminase


GOT = Glutamic Oxalate Transaminase

The rate of NADH to NAD is measured as a decrease in absorbance at 340 nm.


Method:
 IFCC method with / without Pyridoxal 5 phosphate (P5P)
 Decrease UV - kinetic
 Biological reference range:
 15 – 45 IU/L
 Clinical significance:
1. Acute hepatocellular damage
2. Myocardial infarction
3. Congestive heart failure.
4. Biliary tract obstruction
5. Cholicyctisis
5. Cardiac Troponin – I &
Cardiac Troponin - T
 The troponin complex consists of 3 components;
 Troponin C(calcium binding)
 Troponin I(actomysin ATPase inhibitary element)
 Troponin T(tropomyosin binding element).
 Measured by
 ELISA or RIA techniques.
 Immunoturbidometry
 Immuno-diffusion method
 Serum level of troponin T increases within 6 hrs of myocardial
infarction.
 Troponin I is released into the blood within 4 hrs after the
onset of cardiac symtoms.
Biological reference range:-
Troponin I : 0.04 – 40 ng/ml.
Troponin T : 0.01 – 25 ng/ml.

Significance:
For diagnosis of myocardial damage.
Most sensitive
Specific test
Early detectable.
It used mainly in the diagnosis of chest-pain patients
when ECG is normal.
Cardiac Marker
Cardiac Marker
Plasma Enzymes Changes
After Myocardial Infarction
6. myoglobin
 O2 binding protein in skeletal and cardiac muscles
 Released mailnly from skeletal muscle damaged tissues.
 Its level rises more rapidly than C-troponin and CK-MB.

Principle:
 RIA (Radio-Immuno Assay )
 ELISA (Enzyme Link Immuno-Sorbant Assay)
 Chemiluminescence.
Biological reference range:-
25 – 72 ng/ml
Significance:
•Major skeletal muscular injury
•Crush injury
•Burns
7. Lipid profile:
1. Total Cholesterol
2. Triglyceride
3. HDL-cholesterol ( High Density Lipoprotein )
4. LDL-cholesterol ( Low Density Lipoprotein )
5. VLDL-cholesterol ( Very Low Density Liporotein )
 Cholesterol
Principle:

 Absorbance of quinoneimine dye is measured at


500nm.
Method:
• Enzymatic method
Biological reference range:-
Less than 199 mg /dL (Normal)
200 – 239 mg/dl (borderline)
More than 240 mg/dl (high)
Clinical significance : -
Increase cholesterol suggestive of increase probability of following

•Atherosclerosis
•Coronary artery disease
•Ischemic heart disease
•Cerebro-Vascular Stroke
•Hypertension
•Xanthoma

Decrease cholesterol suggestive of increase probability of following

•Depression
 Triglyceride
Principle:

Absorption of quinoneimine dye (red color) is measured at


510nm.

Method :
GPO – POD Method
End point method
Biological reference range:-
<150mg/dl
Clinical significance:
•150 to 400 mg/dl is consider borderline
hypertriglyceridemia.
•More than 400 mg/dl only, increase risk of pancreatitis
HDL , LDL , VLDL
 HDL(High Density Lipoprotine)
Principle:
Precipitates of all lipoprotein other than HDL (LDL &
VLDL lipoproteins)
Precipitation done by
 Dextran Sulfate
 phosphotungsate acid
 Polyethyl glycol
HDL left in the supernatant is tested using cholesterol
assay.
Method: Precipitation reaction
Biological reference range :- 40-60 mg/dl
HDL less than 40mg/dl means high risk of heart disease.
Significance:
HDL transport cholesterol from peripheral tissues to liver
by reverse cholesterol transport.
HDL also helps in the removal of macrophages from the
arterial walls.
 LDL(Low Density Lipoprotien)
Principle:
Direct method: (selective precipitation)

Indirect method: (fridewald equation)


LDL = [Total Cholesterol – HDL] – Plasma TG (mg/dl)
5
Biological reference range:- 130-160 mg/dl
LDL more than 160mg/dl means high risk of heart disease.
Significance:
LDL tarnsport cholesterol from liver to peripheral cells.
 VLDL(very low density
lipoprotien)
Friedewald’s equation:
VLDL = Triglyceride/5 (mg/dl)
Limitation :
Can not useful in case of TG > 400 mg%

Biological reference range:- 2-30 mg/dl


Ratio of Cholesterol
DETERMINATION OF
APOLIPOPROTIEN- A1 & B
METHOD:- Turbidimetric immunoassays (TIA)
PRINCIPLE:-
An insoluble TIA is formed by the reaction between the
apo A-I antigen in human serum & the specific antibody in
the antibody reagent. By using the activactor
reagent,maximum exposure of antigenic sites achieved.
The turbidity is measured at 340nm.
Biological reference range:-
 Apolipoprotein A:-

More than 50mg/dl is desirable.

Apolipoprotein B:-
 less than 80mg/dl is desirable.

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