Enzymatic and non- enzymatic bio marker in Early diagnosis of MI

Enzymatic and non- enzymatic bio markerin Early diagnosis of MI

A cute myocardial infarction (AMI) is theleading cause of death in developedcountries; however, hospital mortalityfrom this cause has been declining overthe last three decades.this reduction inmortality coincides with the improvementin health and living standards and withnew treatments like thrombolysis

And new interventions likepercutaneous coronary interventions(PCI) and coronary artery bypassgrafting(CABG).

The success of treatment rests on:identification of patients in the veryearly stages of AMI

The ideal characteristics of a markerof myocardial injury are: it should beabundant in the myocardium and notpresent in other tissues. This gives it ahigh specificity for the myocardiumand reduces the rate of false positiveresults.

Cardiac markers play an importantrole in the detection of AMI when thepatients history and ECG are nondiagnostic

Cardiac biomarkers• CK-MB is the heart spesificisoenzyme and has been the goldstandard enzyme for the diagnosisof AMI.

Myoglobin• A protein found in striated skeletal andcardiac muscles, myoglobin is an early markerof injury to muscle tissue. A rise in myoglobinconcentration is detectable in blood as earlyas 1 to 3 hours after the onset of MIsymptoms and can be used to rule out thediagnosis in the 2 to 6 hours period after Theonset of symptoms.the disadvantage ofmyoglobin is that it is not cardiac specific.

It can be increased in trauma,diseases of theskeletal muscles,and renal failure. Myoglobinconcentrations for adult men range from 30 to90 ng/dL; women typically demonstrateconcentrations of less than 50 ng/mL.Myoglobin can be measured by latexagglutination,enzyme-linked immunosorbentassay(ELISA),immunonephelometry,andfluoroimmunoassy.A spot test usingimmunochromatography is also available.

troponins• Troponins is a complex of three proteinsthat bind to the thin filaments ofstriated cardiac or skeletal muscle andregulated muscle concetraction. Thecomplex consist of the following :• Troponin T (TnT)• Troponin I (TnI)• Troponin C (TnC)

Troponin I remain invated inblood for 4 to 10 days after MI andthus is valiable for late presentingpatients.

Heart-type acid-binding protein testin the prehospital diagnostic test ofacute myocardial infarction.

Copeptin the release pattern ofcopeptin in patients with AMI withimmediate rise after onset of chestpain and decrease toward physiologiclevels within 5 days.

Myeloperoxidase, but not C-reactiveprotein, predicts cardiovascular risk inperipheral arterial disease, althoughC-reactive protein is a predictor ofinflamatory changes .

Previous Cardiac markers:1- Sgot(Ast).2- LDH.3- Total cpk.