Cardiac Enzyme Markers

Introduction

Cardiac enzyme markers are proteins released into the bloodstream when the heart muscle is damaged. They help doctors diagnose heart attacks and other cardiac conditions. Understanding their role is crucial for early detection and proper treatment.

Key Cardiac Enzyme Markers

1. Troponins (Troponin I and Troponin T)

  • Most specific and sensitive markers for heart muscle damage.
  • Detectable in the blood within 3-6 hours after heart injury.
  • Can remain elevated for 7-14 days.

2. Creatine Kinase-MB (CK-MB)

  • Less specific than troponins.
  • Increases 4-6 hours after heart damage.
  • Peaks at 12-24 hours and returns to normal within 2-3 days.

3. Myoglobin

  • Early but non-specific marker.
  • Rises within 2-4 hours and normalizes quickly (within 24 hours).

Clinical Use of Cardiac Biomarkers

  • Acute Myocardial Infarction (Heart Attack): Troponin is the gold standard for diagnosis.
  • Unstable Angina: Troponins can detect minor myocardial injury.
  • Myocarditis & Heart Failure: Elevated troponins can indicate heart inflammation or ongoing stress.

Limitations & Considerations

  • Some conditions (e.g., kidney disease, sepsis, pulmonary embolism) may also elevate troponins.
  • Serial testing (multiple measurements over time) is critical for accurate interpretation.

Conclusion

Cardiac enzyme markers are invaluable in diagnosing heart attacks. Troponins provide the highest specificity, while CK-MB and myoglobin have supporting roles. Clinical judgment, along with ECG and imaging, ensures accurate diagnosis and optimal treatment.

Source recommendations

1. American Heart Association Guidelines on Cardiac Biomarkers

  1. https://www.ahajournals.org/doi/10.1161/JAHA.117.005852
  2. https://www.acc.org/Latest-in-Cardiology/Articles/2015/02/09/13/00/Cardiac-Biomarkers-and-Heart-Failure
  3. https://www.ahajournals.org/doi/10.1161/cir.0000000000000490
  4. https://www.heart.org/en/-/media/Files/Affiliates/MWA/North-Dakota/North-Dakota-Stroke-Cardiac-Conference/Cardiac-Biomarker-History-Characterization-of-Troponin-Assays-Impact-on-Cardiac-Care-Sep-13-2023.pdf?sc_lang=en
  5. https://pubmed.ncbi.nlm.nih.gov/24222018/

2. European Society of Cardiology Guidelines on Myocardial Infarction

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
  2. https://academic.oup.com/eurheartj/article/44/38/3720/7243210
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Fourth-Universal-Definition-of-Myocardial-Infarction
  4. https://academic.oup.com/eurheartj/article/39/2/119/4095042
  5. https://pubmed.ncbi.nlm.nih.gov/28886621/

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