Transcript The creatine kinase-MB fraction (CK-MB)

Heart profile
Human heart
What Is the Heart?
the heart is a muscular organ that pumps blood to the body. heart is at the
center of the circulatory system. An electrical system controls the heart and
uses electrical signals to contract the heart's walls. When the walls contract
, blood is pumped into the circulatory system. Inlet and outlet valves in the
heart chambers ensure that blood flows in the right direction.
Human heart
. the heart is vital to our health and nearly everything that goes on in our
body. Without the heart's pumping action, blood can't move throughout
your body.
healthy heart supplies our body with the right amount of blood at the rate
needed to work well. If disease or injury weakens our heart, the body's
organs won't receive enough blood to work normally.
Heart structure
the circulatory system or cardiovascular system consist of the heart and
blood vessels, the heart is the key organ in the circulatory system. The
volume of the heart like size of our fist is almost located between the
lungs on the left side.
1)Heart contains four hollow spaces called champers:
left atrium
the right atrium
the left ventricle
the right ventricle
Heart structure
2)blood vessel: a vessel is defined as a hollow container for carrying •
something: a cup, a bucket, a tube. Blood vessels, then, are hollow
container for carrying blood. Located throughout the body.
There are three varieties of blood vessels: arteries, veins, and capillaries.
During blood circulation, the arteries carry blood away from the heart.
The capillaries connect the arteries to veins. Finally, the veins carry the
blood back to the heart.
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heart function
the primary function of the heart
is to pump blood throughout the
body. The regular and
continuous contracting of heart
muscle, myocardium, generates
and sustains an arterial blood
pressure necessary to provide
adequate perfusion of organs.
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heart profile
The major heart test that do on the clinical laboratory is
1)lactate dehydrogenize(LDH)
2) creatine kinase (ck . ck-mb)
3)tropinin 1
Lactate dehydrogenase
This enzyme catalyzes the reversible reaction between pyruvic and lactic
acids.
The lactate dehydrogenase (LDH) test measures the amount of LDH in the
blood
LDH is most often measured to check for tissue damage. The enzyme LDH is
in many body tissues, especially the heart, liver, kidney, skeletal muscle,
brain, blood cells, and lungs
so LDH can be found in many tissues in the body, total LDH is not specific for
heart disease
.
Lactate dehydrogenase
LDH exists in 5 forms, which differ slightly in structures
• LDH-1 is found primarily in heart muscle and red blood cells.
• LDH-2 is concentrated in white blood cells.
• LDH-3 is highest in the lung.
• LDH-4 is highest in the kidney, placenta, and pancreas.
• LDH-5 is highest in the liver and skeletal muscle.
All of these can be measured in the blood
A typical range is 105 - 333 IU/L
Creatine Kinase – CK
enzyme present in high concentration in the cytoplasm of myocytes and is
the most widely used enzyme for evaluation of neuromuscular disease.
In muscles, this enzyme functions by making ATP available for
contraction by the phosphorylation of ADP from creatine phosphate by
catalyzing the reversible phosphorylation of creatine by ATP to form
phosphocreatine + ADP. Phosphocreatine is the major storage form of
high energy phosphate in muscle
Creatine kinase
There are four principle isoenzymes of CK:1-CK-1: BB isoenzyme, found mostly in the brain
2-CK-2: MB isoenzyme, highest concentration in cardiac muscle, with lesser
amounts in skeletal muscle
3-CK-3: MM isoenzyme, found in skeletal muscle, with lesser amounts in
cardiac muscle
4-CK-Mt: Found in mitochondrial membranes, and comprises 15% of total
cardiac CK activity.
Creatine kinase-mb
The creatine kinase-MB fraction (CK-MB) is part of total CK and more
specific for cardiac muscle that other striated muscle. It tends to increase
within 3 to 4 hours of myocardial necrosis, then peak in a day and return
to normal within 36 hours. It is less sensitive than troponins
Total Creatine Kinase (Total CK)Normal Value:38-120 ng/ml
Creatine Kinase-MB (CK-MB)Normal Value:0-3 ng/ml
Troponin 1
• Troponin I and T are structural components of cardiac muscle. They are
released into the bloodstream with myocardial injury. They are highly
specific for myocardial injury--more than CK-MB--and help to exclude
elevations of CK with skeletal muscle trauma. Troponins will begin to
increase following within 3 to 12 hours, about the same time frame as
CK-MB
• Normal Value:<0.4 ng/ml
Lactate dehydrogenase
LDH is most often measured to check for tissue damage.
The enzyme LDH is in many body tissues, especially the heart, liver, kidney,
skeletal muscle, brain, blood cells, and lungs
A typical range is 105 - 333 IU/L (international units per liter
Lactate dehydrogenase is an enzyme that catalyzes the conversion of lactate
to pyruvate. It is not tissue-specific, being found in a variety of tissues,
including liver, heart and skeletal muscle
Elevated LDH levels
Elevated LDH levels :
1- Hemolysis; serum has higher levels than plasma as the enzyme is
released from cells during clotting.
. 2- Physiologic: Exercise
3-Liver disease: Increased LDH1 and LDH2
4-Muscle disease: Increased LDH5.
Lactate dehydrogenase
Higher-than-normal levels may indicate
1- Heart attack
2-Hemolytic anemia
3-Liver disease (for example, hepatitis)
4-Low blood pressure
5- Muscle injury
6-Pancreatitis
7-Tissue dead
Hemolytic anemia
Hemolytic anemia is a condition in which there are not enough red blood
cells in the blood, due to the premature destruction of red blood cells
• Causes
Hemolytic anemia occurs when the bone marrow is unable to increase
production to make up for the premature destruction of red blood cells.).
Creatine Kinase – CK
CK has a very short half life, < 1 hour in horses.
Activity increases quickly (peaks at 6-12 hours) and returns to normal
within 24-48 hours
Total Creatine Kinase (Total CK)Normal Value:38-120 ng/ml
Creatine Kinase-MB (CK-MB)Normal Value:0-3
ng/ml
• The creatine kinase-MB fraction (CK-MB) is part of total CK and
more specific for cardiac muscle
Causes of increased CK
1-Physiologic: CK values in young puppies are higher than in adults
2-· Muscle disease: Detection of increased activity in serum is useful as an
indicator of muscle injury.
3-Artifact: Hemolysis will increase CK values as analytes in red blood cellsor
their membranes (adenylate kinase) contribute to the enzymatic
reaction for CK, artifactually increasing values.
Creatine Kinase
• Creatine Kinase (CK): Unexpectedly High
• Asymptomatic high CK: General
– More common in males than females
– May occur at all ages
heart attack
A heart attack occurs when blood flow to a part of your heart is blocked
for a long enough time that part of the heart muscle is damaged or dies.
caused by a blood clot that blocks one of the coronary arteries.
The coronary arteries bring blood and oxygen to the heart. If the blood flow
is blocked, the heart is starved of oxygen and heart cells die
Creatine Kinase (CK): Low
• Creatine Kinase (CK): Low
• Muscle disease
• Hyperthyroidism
• Multiorgan failure
Rheumatic diseases: Active inflammation
•
Troponins
Troponin Normal Value:<0.4 ng/ml
highly specific for myocardial injury-more thanCK-MB
Troponins will begin to increase within 3 to 12 hours, about the same time
frame as CK-MB
Ischaemic Heart Disease
schaemic Heart Disease, otherwise known as Coronary Artery Disease, is a
condition that affects the supply of blood to the heart.
The blood vessels are narrowed or blocked due to the deposition of
cholesterol plaques on their walls. This reduces the supply of oxygen and
nutrients to the heart musculature,
Ischemic heart disease is caused by an imbalance between the myocardial
blood flow and the metabolic
Laboratory Procedure Manual
Analyte: Lactate Dehydrogenase •
Matrix: Refrigerated Serum •
Method: Beckman Synchron LX20 •
TEST PRINCIPLE
The LX20 with LD reagent (using lactate as substrate) utilizes an
enzymatic rate method to measure LD activity in biological
fluids. In the reaction,
the LD catalyzes the reversible oxidation of L-Lactate to
Pyruvate with the concurrent reduction of ß-nicotinamide
adenine dinucleotide (NAD) to ß-nicotinamide adenine
dinucleotide hydroxylase (reduced form; NADH).
The system monitors the rate of change in absorbance at 340
nm over a fixed time interval.
The rate of change in absorbance is directly proportional to the
activity of LD in the sample
references
http://www.student.med.umn.edu/wardmanual/normallabs.php •
http://library.med.utah.edu/WebPath/TUTORIAL/MYOCARD/MYOCARD.ht
ml
http://ahdc.vet.cornell.edu/clinpath/modules/chem/ck.htm •
http://www.nlm.nih.gov/medlineplus/ency/article/003471.htm •
http://neuromuscular.wustl.edu/lab/cknomyo.html •
http://www.fi.edu/learn/heart/history/history.html •
http://www.nhlbi.nih.gov/health/health-topics/topics/hhw/
http://www.cdc.gov/nchs/data/nhanes/nhanes_03_04/l40_c_met_lactate
_dehydrogenase.pdf
http://www.med.uc.edu/kranias/cardiac_function.htm
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By:
rahaf babgi
Alaa alamoudi