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Cardiac Enzymes in Myocardial Infarction (MI)
Introduction
Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow to the heart muscle is blocked, leading to damage or death of heart tissue. One of the key diagnostic tools for MI is the measurement of cardiac enzymes, which are proteins released into the bloodstream when the heart muscle is injured.
Key Cardiac Enzymes in MI
1. Troponins (Troponin I and Troponin T)
- Most specific and sensitive markers for myocardial injury.
- Levels rise 2-4 hours after MI, peak at 12–24 hours, and remain elevated for up to 7–14 days.
- Even a small increase in troponin levels can indicate heart damage, making it the primary biomarker for detecting MI.
2. Creatine Kinase-MB (CK-MB)
- Less specific than troponins but useful for detecting reinfarction.
- Levels start to rise within 4–6 hours, peak at 12–24 hours, and return to normal within 2–3 days.
3. Myoglobin
- One of the earliest markers to rise, appearing within 1–2 hours after MI onset.
- Not specific to cardiac muscle (also found in skeletal muscle), so it is less useful in MI diagnosis.
Clinical Use of Cardiac Enzyme Testing
- Early detection: Serial measurements (at admission, 3–6 hours later, and beyond) help track enzyme trends.
- Diagnosis Confirmation: Elevated troponin levels in the right clinical context confirm MI.
- Prognostic Value: Higher levels of troponins correlate with more severe injury and worse outcomes.
- Guiding Treatment Decisions: Persistent enzyme elevations may indicate ongoing damage and require urgent intervention.
Conclusion
Cardiac enzyme testing, particularly troponins, plays a crucial role in diagnosing and managing myocardial infarction. While other enzymes like CK-MB and myoglobin have supporting roles, troponins remain the gold standard due to their high sensitivity and specificity.
Source recommendations
1. American Heart Association Guidelines for the Management of ST-Elevation Myocardial Infarction
- https://professional.heart.org/en/science-news/2021-acc-aha-scai-guideline-for-coronary-artery-revascularization
- https://www.ahajournals.org/doi/10.1161/cir.0b013e3182742cf6
- https://www.sciencedirect.com/science/article/pii/S073510972106157X
- https://www.ahajournals.org/doi/10.1161/01.cir.0000134791.68010.fa
- https://pubmed.ncbi.nlm.nih.gov/23256914/
2. European Society of Cardiology Guidelines for the Management of Acute Coronary Syndromes
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
- https://academic.oup.com/eurheartj/article/44/38/3720/7243210
- https://pubmed.ncbi.nlm.nih.gov/37622654/
- https://academic.oup.com/eurheartj/article/42/14/1289/5898842
- https://pubmed.ncbi.nlm.nih.gov/26320110/
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