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Cardiac function test

Cardiac function test. By : zalak , jemisha , namrta , priyanka , kalyani , dipika. I ntroduction. Cardiac function tests used to determine whether there has been any cardiac tissue damage. This tests performed to help diagnose a cardiac disease. Myocardial infarction

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Cardiac function test

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  1. Cardiac function test By : zalak , jemisha , namrta , priyanka , kalyani , dipika

  2. Introduction Cardiac function tests used to determine whether there has been any cardiac tissue damage. This tests performed to help diagnose a cardiac disease. Myocardial infarction Coronary artery disease Atherosclerosis

  3. Cardiac function tests include CK (Creatine kinase) CK-MB LDH (Lactate Dehydrogenase) SGOT Troponin Myoglobin Lipid Profile : Cholesterol Triglyceride HDL-cholesterol LDL-cholesterol VLDL-cholesterol LDL/HDL ratio LDL/Total cholesterol Apolipoprotein – A1 Apolipoprotein - B

  4. 1. CK (CREATINE KINASE) Principle:

  5. Method : Increasing Kinetic Biological reference range :- 25-120 U/L Clinical Significance: CPK ( Creatine phosphokinase ) activity is increase in Brain (CK-BB = 1%) Cerebro-vascular stroke heart muscle (CK-MB = 5-10%) Myocardial infarction Acute coroary syndrome skeletal muscle. (CK-MM= 85%) Crush injury Myopathy Polymyositis

  6. 2. CK-MB Principle: measurement of CK activity in the presence of an antibody to CK-M monomer. This antibody completely inhibits the activity of CK-MM & half of the activity of CK-MB while not affecting the B subunit activity of CK-MB &CK-BB. Method : Increasing Kinetic UV method

  7. Biological reference range :-0 - 25 IU/L Significance: CK-MB present only in cardiac tissue So…Specific for diagnosis of cardiac disease

  8. CK-2 & CK-3 in normal subject & After 24 hours of Myocardial Infarction Creatine Kinase isoenzymes in blood

  9. 3. LDH (lactate dehydrogenase) Principle: Lactate dehydrogenase catalyses the conversion of pyruvate to lactate. Lactate dehydrogenase Lactate + NAD+ ---------------- Pyruvate + NADH + H+ The rate of NADH+ formation is measured by 340nm filter. It is direactlypropotional to serum LDH activity.

  10. Method : IFCC method (Lactate to Pyruvate method ) Increasing kinetic Biological reference range :- 70-240 IU/L Clinical significance : RBC Malaria Sickle cell anemia hemolytic disorder Liver Viral Hepatitis Liver malgnancy Alcoholic liver disease Cardiac tissue Myocardial infarction Skeletal muscle Muscular distrophy Crush injury

  11. LDH Iso-enzyme

  12. 4. GOT ( AST ) Principle: L-Aspartate+αKetoglutarateGOT(withP5P) Oxaloacetate + LGlutamate Oxaloacetate + NADH + H+ MDH Malate + NAD+ AST = Aspartate Transaminase GOT = Glutamic Oxalate Transaminase The rate of NADH to NAD is measured as a decrease in absorbance at 340 nm. Method: IFCC method with / without Pyridoxal 5 phosphate (P5P) Decrease UV - kinetic

  13. Biological reference range: 15 – 45 IU/L Clinical significance: Acute hepatocellular damage Myocardial infarction Congestive heart failure. Biliary tract obstruction Cholicyctisis

  14. 5. Cardiac Troponin – I & Cardiac Troponin - T The troponin complex consists of 3 components; Troponin C(calcium binding) Troponin I(actomysin ATPase inhibitary element) Troponin T(tropomyosinbinding element). Measured by ELISA or RIA techniques. Immunoturbidometry Immuno-diffusion method Serum level of troponin T increases within 6 hrs of myocardial infarction. Troponin I is released into the blood within 4 hrs after the onset of cardiac symtoms.

  15. Biological reference range:- Troponin I : 0.04 – 40 ng/ml. Troponin T : 0.01 – 25 ng/ml. Significance: For diagnosis of myocardial damage. Most sensitive Specific test Early detectable. It used mainly in the diagnosis of chest-pain patients when ECG is normal.

  16. Cardiac Marker

  17. Cardiac Marker Plasma Enzymes Changes After Myocardial Infarction

  18. 6. myoglobin O2 binding protein in skeletal and cardiac muscles Released mailnly from skeletal muscle damaged tissues. Its level rises more rapidly than C-troponin and CK-MB. Principle: RIA (Radio-Immuno Assay ) ELISA (Enzyme Link Immuno-Sorbant Assay) Chemiluminescence.

  19. Biological reference range:- 25 – 72 ng/ml Significance: Major skeletal muscular injury Crush injury Burns

  20. 7. Lipid profile: Total Cholesterol Triglyceride HDL-cholesterol ( High Density Lipoprotein ) LDL-cholesterol ( Low Density Lipoprotein ) VLDL-cholesterol ( Very Low Density Liporotein )

  21. Cholesterol Principle: • Absorbance of quinoneimine dye is measured at 500nm. • Method: • Enzymatic method

  22. Biological reference range:- Less than 199 mg /dL (Normal) 200 – 239 mg/dl (borderline) More than 240 mg/dl (high) Clinical significance : - Increase cholesterol suggestive of increase probability of following Atherosclerosis Coronary artery disease Ischemic heart disease Cerebro-Vascular Stroke Hypertension Xanthoma Decrease cholesterol suggestive of increase probability of following Depression

  23. Triglyceride Principle: Absorption of quinoneimine dye (red color) is measured at 510nm. Method : GPO – POD Method End point method

  24. Biological reference range:- <150mg/dl Clinical significance: 150 to 400 mg/dl is consider borderline hypertriglyceridemia. More than 400 mg/dl only, increase risk of pancreatitis

  25. HDL , LDL , VLDL

  26. HDL(High Density Lipoprotine) Principle: Precipitates of all lipoprotein other than HDL (LDL & VLDL lipoproteins) Precipitation done by Dextran Sulfate phosphotungsate acid Polyethyl glycol HDL left in the supernatant is tested using cholesterol assay. Method: Precipitation reaction

  27. Biological reference range :- 40-60 mg/dl HDL less than 40mg/dl means high risk of heart disease. Significance: HDL transport cholesterol from peripheral tissues to liver by reverse cholesterol transport. HDL also helps in the removal of macrophages from the arterial walls.

  28. LDL(Low Density Lipoprotien) Principle: Direct method: (selective precipitation) Indirect method: (fridewald equation) LDL = [Total Cholesterol – HDL] – Plasma TG (mg/dl) 5

  29. Biological reference range:- 130-160 mg/dl LDL more than 160mg/dl means high risk of heart disease. Significance: LDL tarnsport cholesterol from liver to peripheral cells.

  30. VLDL(very low density lipoprotien) Friedewald’s equation: VLDL = Triglyceride/5 (mg/dl) Limitation : Can not useful in case of TG > 400 mg% Biological reference range:-2-30 mg/dl

  31. Ratio of Cholesterol

  32. DETERMINATION OF APOLIPOPROTIEN- A1 & B METHOD:- Turbidimetric immunoassays (TIA) PRINCIPLE:- An insoluble TIA is formed by the reaction between the apo A-I antigen in human serum & the specific antibody in the antibody reagent. By using the activactorreagent,maximum exposure of antigenic sites achieved. The turbidity is measured at 340nm.

  33. Biological reference range:- Apolipoprotein A:- More than 50mg/dl is desirable. Apolipoprotein B:- less than 80mg/dl is desirable.

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