Acute coronary syndrome such as acute myocardial infarction (AMI) or unstable angina often results from rupture of atherosclerotic plaques. In the case of AMI, the occlusion of coronary blood vessels by clots stops the blood flow to myocardial muscle cells. The cells necrotize due to oxygen depletion resulting in damage of cardiac tissue.
Acute coronary syndromes are followed by angina pectoris or other ischemic symptoms and have to be treated as an emergency. Changes in the electrocardiogram (ECG) are the first and most important diagnostic tool in AMI.
Cardiac markers are biochemical markers for the evaluation of myocardial injury that are released into the blood from necrotizing heart tissue.
As one of the earliest markers, myoglobin can already be measured 2 - 3 hours from onset of chest pain, reaching peak levels after 7 - 10 hours and returning to values within the reference range after approx. 24 hours. The determination of myoglobin represents an early and sensitive laboratory test, which complements the ECG during the early phase of AMI. Additionally, myoglobin is a valuable tool to monitor the success of thrombolytic therapy.
Cardiac troponins are the most sensitive markers that were integrated in most guidelines over the last years. When Troponins are not available and in case of suspected reinfarction, measurement of creatine kinase (CK) in combination with creatine kinase-MB (CK-MB) are still valuable markers for diagnosis and monitoring of myocardial infarction.
Creatinine kinase is a dimer consisting of two isoenzymes of the muscle (CK-M) and the brain (CK-B). CK-MM, CK-MB, and CK-BB are mostly present in muscle tissue, heart tissue, and brain tissue respectively. Due to the different origins, the measurement of CK-MB to CK- ratio reveals a more powerful diagnostic tool.
Lactate-Dehydrogenase (LDH) and α-Hydroxybutyrate-dehydrogenase (HBDH) were some of the first used cardiac markers. Due to the different specificity and origin of α-HBDH, an isoenzyme of LDH, the ratio between the two enzyme activities should be considered. Due to their late increase and long half-life, α-HBDH can indicate past and non-symptomatic heart attacks.
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