Cardiac Markers for Myocardial Infarction (MI)

Introduction

Myocardial infarction (MI), commonly known as a heart attack, occurs due to the blockage of a coronary artery, leading to ischemia (lack of oxygen) and damage to the heart muscle. Cardiac biomarkers play a critical role in diagnosing MI by detecting myocardial injury.

Key Cardiac Biomarkers

1. Troponins (cTnI and cTnT)

  • Most specific and sensitive markers for myocardial damage.
  • Levels rise 2-4 hours after MI onset, peak at 12-24 hours, and remain elevated for up to 10-14 days.
  • High-sensitivity troponin (hs-cTn) tests improve early detection.

2. Creatine Kinase-MB (CK-MB)

  • Less specific than troponins but useful for detecting reinfarction.
  • Levels increase 3-6 hours after MI, peak at 12-24 hours, and return to normal within 48-72 hours.

3. Myoglobin

  • Rises earliest (within 1-2 hours) but lacks specificity.
  • Used in combination with other markers for early exclusion of MI.

4. Lactate Dehydrogenase (LDH)

  • Previously used but now considered less reliable.
  • Levels peak at 72 hours and return to normal within 7-14 days.

Diagnostic Approach Using Cardiac Markers

  1. Measure troponins at initial presentation and repeat after 3-6 hours.
  2. Look for a rise and/or fall pattern in values to confirm myocardial injury.
  3. Combine biomarker analysis with ECG findings and clinical symptoms for accurate diagnosis.

Conclusion

Cardiac biomarkers, especially high-sensitivity troponins, are essential for the early and accurate diagnosis of MI. Their use in combination with clinical assessment and ECG enhances the reliability of the diagnosis.

Source recommendations

1. American Heart Association (AHA) Guidelines for the Management of Myocardial Infarction

  1. https://www.ahajournals.org/doi/10.1161/01.cir.94.9.2341
  2. https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack
  3. https://www.ahajournals.org/doi/10.1161/cir.0000000000001030
  4. https://professional.heart.org/en/science-news/2022-acc-aha-key-data-elements-and-definitions-for-chest-pain-and-acute-myocardial-infarction
  5. https://pubmed.ncbi.nlm.nih.gov/15289388/

2. European Society of Cardiology (ESC) Guidelines for 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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