Cardiovascular Markers

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Conclusion of AMI. In view of 2 out of 3 of WHO criteria (Circulation 90:583-612, 1979)Prolonged mid-section pain\"Silent infarct\", Painless infarctECG changes Lacks affectability? Serum catalyst focuses CKMB needs affectability in determination of perioperative MIProtein markers developing in the 21st century.

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Cardiovascular Markers Resident Rotation in Clinical Chemistry 2005-2006

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Diagnosis of AMI Based on 2 out of 3 of WHO criteria (Circulation 90:583-612, 1979 ) Prolonged trunk torment "Silent infarct", Painless infarct ECG changes Lacks affectability  Serum catalyst focuses CKMB needs affectability in conclusion of perioperative MI Protein markers developing in the 21st century

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Cardiac Markers of the 21Century MB isoenzyme CKMM isoforms CKMB isoforms Myoglobin Troponin I Troponin T

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Components in CK Isoenzymes CK-3 (CK-MM) in Skeletal muscle CK-2 (CK-MB) 10-20% in myocardium <2% in skeletal muscle CK-1 (CK-BB) Macro CKs Type 1 Complex shaped between CK-BB and immunoglobulin Type 2 Mitochondria CK

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MB Index MB Index = (CKMB/add up to CK) x 100 Rationale for utilizing MB Index Using CKMB alone (RI <4.7 ng/mL) regularly yields FP comes about Combined use with MB Index discounts patients with skeletal muscle damage What cut-off an incentive for MB Index to utilize?

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Sensitivity Specificity MB Index Sensitivity & specificity are resolved individually at MB Index of qualities 0 - 10

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Limitations of CKMB FP occurrences in perioperative patients without heart harm False rises in False heights in: Skeletal muscle damage Marathon runners Chronic renal disappointment Hypothyroidism MI discovery not sufficiently auspicious for thrombolytic intercession. MB topping takes >12h

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Myoglobin & CKMB in ordinary MI 3 tests drawn inside 2 h

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MI Concomitant with Renal Failure 3 tests drawn inside 2 h

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CKMB & Tpn I in AMI

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B A = myoglobin or CKMB isoforms B = cardiovascular troponin C = CKMB D = heart troponin after shaky angina An A C A D Marker Responses to AMI

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Troponin Release Kinetics Pattern of discharge in MI is BIPHASIC. Perceptible in blood 4-12 h, like CKMB Peaks 12-38 h Remains lifted for 5-10 days

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Receiver working trademark (ROC) Curve for Tn T Plot of Sensitivity (TP) versus 1-specificity (FP) Used for setting up best discriminator for cTnT for foreseeing AMI Best discriminator point is 0.2  g/L at 9 h after onset of AMI