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ATPase inhibitory subunit) and troponin T (tropomyosin binding Name of the marker Reference value subunit). Cardiac iso form is specific for carA. Markers for Myocardial infarction diac muscle. They are generally identified and 1. Cardiac troponins (cTnT and cTnI) TnT values below 0.01 microgram/litre quantitated by immunological (ELISA or TnI values below 0.10 microgram/litre immunoturbidimetric) reactions. Troponins 2. High sensitivity troponin (hsTnT) Less than 14 nanogram / litre are seen in skeletal and 3. Creatinine kinase (CK) 15–100 U/L for males and 10–80 U/L for females cardiac muscles, but not in smooth muscles. B. Mark ers ffor or card iac failure or v entricular dysfunction Markers ventricular The cTnT and cTnI 1. BNP demonstrate similar diagnostic ability in deLess than 400 ng/L 2. NT-proBNP tection of myocardial C.Mark ers ffor or Risk of Card iac d isease (pred iction) C.Markers damage despite analytical differences. Both 1.Total cholesterol level in serum 150 to 200 mg/dL the Joint ESC/ACCF/ Under 130 mg/dL 2. LDL cholesterol AHA/WHF Task Force for the Universal Defi40-60 mg/dL 3. HDL cholesterol nition of Myocardial InLess than 130 mg/dL 4. Apo B100 level farction and the National Academy of Clini5. Apo A1 level More than 120 mg/dL cal Biochemistry rec6. Ratio of Apo B : A-I Ratio of 0.4 ommend a 20% change from an elevated cTn Values between 100-130 mg/dL 7. Non-HDL cholesterol value as indicative of 8. Plasma hsCRP 0.1 mg /dL additional myocardial necrosis. This 20% 9. Lp(a) level Less than 30 mg/dL change represents a 10. Serum Triglycerides 50-150 mg/dL significant (>3 standard deviations of the variation associated with an Accordingly, some have advocated relying solely on troponin elevated baseline concentration) change in cTn on the basis of a and discontinuing the use of CK-MB and other markers. Neverthe- 5–7% analytical total CV. Cardiac troponin elevations at lower less, CK-MB and other markers continue to be used in some Table 2: Cl inical c ond itions hospitals to rule out MI and to monitor for additional cardiac cond muscle injury over time. where the markers are tested

Cardiac Biomarkers

Note that cardiac markers are not necessary for the diagnosis of patients who present with ischemic chest pain and diagnostic ECGs with ST-segment elevation. These patients may be candidates for thrombolytic therapy or primary angioplasty. Treatment should not be delayed to wait for cardiac marker results, especially since the sensitivity is low in the first 6 hours after symptom onset. ACC/American Heart Association (AHA) guidelines recommend immediate reperfusion therapy for qualifying patients with ST-segment elevation MI (STEMI), without waiting for cardiac marker results.

CARDIAC TROPONINS (CTI / CTT) Troponins are specific markers for myocardial infarction. Measurement of cardiac troponins has become one of the main tests in early detection of an ischemic episode and in monitoring the patient. The troponin complex consists of 3 components; troponin C (calcium binding subunit), troponin I (actomyosin

Cardiac Markers are tested in 1. Any chest pain 2. Unstable angina 3. Suspicious ECG changes 4. History suggestive of myocardial infarction 5. Following surgical coronary revascularization

When should check Lipid Profile? 1. Suspected cardiovascular disease, coronary artery disease and peripheral vascular disease 2. All patients with diabetes mellitus, at least once in 6 months. 3. Thyroid, liver and renal diseases, where lipid metabolism may be altered.

6. Patients with hypotension 4. All persons above 40, should and dyspnea be checked once in a year

TECHAGAPPE

APRIL-JUNE 2018

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Techagappe 15th edition (April - June 2018) E-book  

Agappe Diagnostics Limited is the first Indian IVD company publishing an International Diagnostic News Journal “Techagappe” for the public t...

Techagappe 15th edition (April - June 2018) E-book  

Agappe Diagnostics Limited is the first Indian IVD company publishing an International Diagnostic News Journal “Techagappe” for the public t...

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