Exam 1 - Cardiac Enzymes
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| What kind of specimen is required for cardiac enzyme analysis? | Serum or heparinized plasma lacking hemolysis
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| If testing cannot be performed immediately how must the specimen be stored? | At 4 deg C in the dark (for up to 7 days)
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| What are the major sources of CK in the body? | Skeletal muscle, myocardium, brain.
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| What do increased levels of CK indicate? | Tissue damage such as AMI, autoimmune muscle disease, or that an athletic workout has occurred.
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| If the total CK is greater than _____ U/L an isoenzyme assay is indicated. | Greater than 215 U/L.
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| If the total CK is greater than _____ U/L a dilution will be required. | Greater than 400 U/L.
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| CK1 (CKBB) is associated with which tissue/ organ? | Brain
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| CK2 (CKMB) is associated with which tissue/ organ? | Myocardium
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| CK3 (CKMM) is associated with which tissue/ organ? | Muscle
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| The forward reaction of the CK enzyme assay is done at which pH? | pH 6.8
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| The reverse reaction of the CK enzyme assay is done at which pH? | pH 9.0
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| Normal serum contains what percentage of CKMB? | 3-6%
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| CKMM will be elevated after: | Muscle trauma, muscular dystrophy, Reye's syndroms, hypothyroidism.
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| CKBB can be elevated after: | Normal child birth, tumors, shock syndrome.
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| CKMB is elevated after: | Myocardial injury, brain injury, carbon monoxide poisoning
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| Which cardiac protein/ enzyme is first to rise after AMI? | Myoglobin
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| What is the purpose of the CKMB relative index (RI)? | It relates CKMB mass to CK activity.
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| Is a CKMB mass of less than 10ng/ mL useful in the determination of CKMB RI? | NO, CKMB hass to be greater than 10 ng/mL.
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| Is a normal (within reference range) total CK useful in the determination of CKMB RI? | NO
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| List some factors that can affect interpretation of CK isoenzyme results. | Exercise, age, gender, supplement use.
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| What are the major sources of LD in the body? | Kidney, liver, heart
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| List some conditions that will have elevated levels of LD. | AMI, hemolysis, cirrhosis, hepatits, muscular dystrophy, pernicious anemia, malignancy.
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| What level does total LD have to be at to indicate isoenzyme evaluation? | Greater than 180 U/L
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| Is CK a tetramer or a dimer? | Dimer
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| Is LD a tetramer or a dimer? | Tetramer
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| In the heart, LD1 is greater than/ less than LD2? (Select one) | GREATER THAN
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| In the skeletal muscle, LD1 is greater than/ less than LD2? | LESS THAN
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| Serum levels of LD1 > LD2 indicate what? What is this called? | Myocardial injury
LD1/LD2 Flip
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| CKMb rises how many hours after AMI? | 6-8 hrs
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| LD1 rises how many hours following chest pains? Peaks? Returns back to baseline? | 8-12 hrs
Peak: 24- 48 hrs
Returns: 7- 12 days
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| How many hours after AMI will AST rise? | 6- 8 hrs
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| What is AST formerly known as? | SGOT
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| List the major sources of AST in the body. | ALL body tissues, especially heart, liver skeletal muscle
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| True or false: AST levels can be used alone to diagnose AMI? | FALSE
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| List some conditions that will elevate AST levels. | AMI, kidney damage, jaundice, metastasis, peripheral muscle disease, crush injury, muscular dystrophy, ingestion of aspirin, codeine, cortisone, shock, circulatory collapse, liver damage.
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| For the first 48 hours of hospital stay for AMI, cardiac enzymes should be drawn how often. | Every 8- 12 hrs.
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| True or false: If a sample was collected within 48 hours of chest pain and CKMB is ABSENT, the person is definitely not having an AMI. | TRUE
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| True or false: If a sample was collected within 48 hours of chest pain and CKMB is present with LD1/ LD2 levels normal, it most definitely is not an AMI. | FALSE. Seen in both AMI and non- AMI.
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| True or false: If a sample was collected within 48 hours of chest pain and the LD1/ LD2 flip is present, it is not a heart attack. | FALSE.
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| How soon following AMI will myoglobin be released? When is the peak? When will it return baseline? | 2- 4 hrs.
Peak: 8- 12 hrs
Back to baseline: 18- 24 hrs
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| What is the half life of myoglobin? | 10 min.
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| List some causes of myoglobinemia. | Angina without infarction, muscle trauma, renal failure, open heart surgery, myopathies, IM injection, electric shock, vigorous exercise.
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| Which component of the troponin complex is more specific than CKMB for AMI? | Troponin I
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| Troponin I rises within how many hours of chest pain? Peaks? | Rises within 4-8 hours.
Peaks: 12- 16 hours
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| True or false: The magnitude of troponin I indicates the size of the infarction. | TRUE
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| What protein/ enzyme can be used for a marker of artherosclerosis? | CRP
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| What level of CRP indicated a low risk of artherosclerosis? | < 1 mg/ L
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| What level of CRP indicates an intermediate risk for artherosclerosis? | 1- 3 mg/L
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| What level of CRP indicates a high risk for arthersclerosis? | Greater than 3 mg/ L
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| What is the main source of brain natriuretic peptide (BNP) in the body? | Heart ventricles
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| Elevated BNP indicates what conditions? | Congestive heart failure or hypertension
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| What are some risk factors for coronary heart disease? | cigarettes, increased blood pressure, diabetes, dyslipidemia, initiating factor of injury or inflammation
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| List 2 disease conditions that can affect serum cholesterol. | Hypothyroidism
Nephrotic syndrome
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