Clinical Enzymes in Myocardial Infarction Diagnosis
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Questions and Answers

Which enzyme is primarily assessed for diagnosing myocardial infarction?

  • Cardiac Troponins (correct)
  • Serum Aspartate Amino Transferase (AST)
  • Myoglobin
  • Lactate Dehydrogenase (LDH)

    • What indicates cell damage particularly related to myocardial infarction on enzyme analysis?

  • Normal levels of Lactate Dehydrogenase (LDH)
  • Increased levels of Myoglobin (correct)
  • Stable Cardiac Troponins
  • Decreased Serum Aspartate Amino Transferase (AST)

    • How does Lactate Dehydrogenase (LDH) help in understanding tissue damage?

  • It is exclusively released from cardiac tissues.
  • It provides immediate diagnosis within the first hour of injury.
  • It shows increased levels only after 48 hours of myocardial infarction. (correct)
  • It is a non-functional enzyme in plasma.

    • Which of the following enzymes has no functional role in blood plasma under normal conditions?

    <p>Non-Functional Enzymes</p> Signup and view all the answers

    What is the primary role of Myoglobin as a cardiac marker?

    <p>To indicate early muscle injury.</p> Signup and view all the answers

    Which non-functional plasma enzyme is specifically increased in cases of acute pancreatitis?

    <p>Amylase</p> Signup and view all the answers

    What is the significance of Lactate Dehydrogenase (LDH) in clinical diagnostics?

    <p>Elevated in blood, heart, and liver diseases</p> Signup and view all the answers

    Which enzyme measurement is NOT typically associated with liver diseases?

    <p>Creatine Kinase</p> Signup and view all the answers

    In evaluating cardiac conditions, which enzyme is primarily used as a marker for myocardial infarction?

    <p>Creatine Kinase (CK)</p> Signup and view all the answers

    What is primarily indicated by elevated levels of Acid Phosphatase in plasma?

    <p>Prostate cancer</p> Signup and view all the answers

    Which of the following cardiac markers is released into the bloodstream during myocardial cell injury?

    <p>Creatine Kinase</p> Signup and view all the answers

    What does a significant increase in Serum Aspartate Amino Transferase (AST) suggest?

    <p>Liver and heart diseases</p> Signup and view all the answers

    Myoglobin is primarily a cardiac marker for which condition among the following?

    <p>Myocardial infarction</p> Signup and view all the answers

    Which enzyme is primarily associated with myocardial infarction and also elevated in skeletal muscle disease?

    <p>Creatine kinase (CK)</p> Signup and view all the answers

    Which enzyme activity increases primarily in response to liver conditions involving cell damage, such as hepatitis?

    <p>Aspartate Amino transferase (AST)</p> Signup and view all the answers

    What is the role of Lactate Dehydrogenase (LDH) in the context of cardiac health?

    <p>It rises in cases of myocardial infarction and various liver diseases.</p> Signup and view all the answers

    Which enzyme is primarily linked to detecting prostatic carcinoma?

    <p>Acid Phosphatase (ACP)</p> Signup and view all the answers

    Which cardiac marker is sensitive and specific for myocardial injury, aside from traditional enzymes?

    <p>Cardiac Troponins</p> Signup and view all the answers

    Which enzyme is strongly associated with biliary obstruction in liver diseases?

    <p>Alkaline Phosphatase (ALP)</p> Signup and view all the answers

    What differentiates Aspartate Amino Transferase (AST) from Alanine Amino Transferase (ALT) in clinical diagnostics?

    <p>AST can be elevated in both liver and myocardial diseases.</p> Signup and view all the answers

    Which factor can lead to elevated levels of y glutamyl Transferase (y GT)?

    <p>Biliary obstruction and liver cirrhosis</p> Signup and view all the answers

    Which enzyme activity is typically assessed for diagnosing conditions other than those affecting the liver or heart?

    <p>Acid Phosphatase (ACP)</p> Signup and view all the answers

    In which scenario is Alanine Amino Transferase (ALT) most commonly elevated?

    <p>Severe liver disease with cell damage</p> Signup and view all the answers

    Which enzyme is primarily utilized as a marker for muscle injury due to its steady rise and fall after damage?

    <p>Creatine kinase (CK)</p> Signup and view all the answers

    What is the role of lactate dehydrogenase (LDH) in disease diagnosis?

    <p>It serves as a tumor marker but cannot specify cancer types.</p> Signup and view all the answers

    How soon after an acute pancreatitis can amylase levels be expected to rise above diagnostic levels?

    <p>Within 24 hours</p> Signup and view all the answers

    Which enzyme is primarily involved in the evaluation of acute myocardial infarction?

    <p>Streptokinase</p> Signup and view all the answers

    Which of the following enzymes is used in the management of inflammation due to injury?

    <p>Streptokinase</p> Signup and view all the answers

    Which of the following markers has a short half-life and is less useful for diagnosing muscle damage in later stages?

    <p>Myoglobin</p> Signup and view all the answers

    What does the International Normalized Ratio (INR) measure?

    <p>Patient's prothrombin time compared to a control</p> Signup and view all the answers

    What is the role of serum lactate dehydrogenase (LDH) in clinical diagnostics?

    <p>It signifies advanced malignancies and leukemias</p> Signup and view all the answers

    In which condition would elevated serum alkaline phosphatase levels be most significantly observed?

    <p>Paget's disease</p> Signup and view all the answers

    Which enzyme can be elevated in both liver disease and muscle damage?

    <p>Aspartate transferase (AST)</p> Signup and view all the answers

    Which enzyme is specifically mentioned as a tumor marker for liver cell carcinoma?

    <p>Leucine amino peptidase (LAP)</p> Signup and view all the answers

    Which of the following conditions can elevate lactate dehydrogenase (LDH) levels?

    <p>Hypothyroidism</p> Signup and view all the answers

    What therapeutic use does L-asparaginase have in the medical field?

    <p>It hydrolyzes L-asparagine to inhibit tumor growth</p> Signup and view all the answers

    Which serum enzyme would NOT typically be elevated in bone disease?

    <p>Gamma-glutamyl transferase (GGT)</p> Signup and view all the answers

    Which of the following conditions is NOT associated with elevated lipase levels?

    <p>Chronic kidney disease</p> Signup and view all the answers

    In relation to cardiac function, troponin is used as a definitive marker due to what reason?

    <p>It has higher specificity for cardiac injury.</p> Signup and view all the answers

    What is the primary function of urokinase in medical treatments?

    <p>To initiate thrombolysis in pulmonary embolism</p> Signup and view all the answers

    What is primarily responsible for the conversion of lactate to pyruvic acid?

    <p>Lactate dehydrogenase (LDH)</p> Signup and view all the answers

    Which enzyme's elevated levels may indicate metastasis in the liver?

    <p>Serum alkaline phosphatase</p> Signup and view all the answers

    In the context of tumor markers, what does elevated neuron specific enolase indicate?

    <p>Nervous tissue malignancies</p> Signup and view all the answers

    Study Notes

    Patient Complaints and Examination

    • Pale stool and dark urine are noted
    • Complaints include anorexia, nausea, vomiting, pruritus, and severe abdominal pain
    • Fever and chills are also reported
    • Examination reveals the patient is fat, fertile, and has a palpable gallbladder

    Laboratory Findings

    • Serum bilirubin (conjugated and unconjugated)
    • Urobilinogen
    • Urinary bilirubin
    • Urinary bile salts
    • Serum ALP
    • Serum GGT
    • Serum 5'-nucleotidase
    • Transaminases (mildly raised)

    Ultrasound Findings

    • Ultrasound shows possible gallstones
    • A stone may be impacted in the cystic duct or gall bladder
    • Other possible findings include biliary pain or acute cholecystitis, stone in the common bile duct
    • The findings might show obstructive jaundice or cholangitis

    Clinical Enzymology

    • Diagnostic Enzymology is used to diagnose: Myocardial infarction, Liver disease, Bone disease, Muscle disease, and Cancer
    • Therapeutic Enzymology provides diagnostic tools

    Types of Enzymes in Blood Plasma

    • Functional enzymes (in plasma) are attached to endothelial cells in capillaries, examples include lipoprotein lipase and zymogens for blood coagulation
    • Non-functional enzymes are functional in cells, example of such enzymes include those involved in cell turnover or disease

    Two Major Types of Plasma Enzymes

    • Functional enzymes have high concentrations in the plasma and specific substrates
    • Examples of functional enzymes include lipoprotein lipase
    • Non-functional enzymes have normal low levels due to cell destruction. Elevated levels, indicate tissue necrosis/cell proliferation

    Non-Functional Plasma Enzymes

    • Enzymes are not normally found in blood but are present in cells
    • If found in blood, it usually points to cellular abnormalities (e.g., cell damage, cancer).
    • Elevated tissue-specific enzymes or isoenzymes suggest tissue disease

    Clinical Importance

    • Measuring non-functional plasma enzymes helps diagnose organ diseases reflected by increased enzymes
    • Monitoring plasma enzymes before and after treatment assesses treatment efficacy and prognosis

    Medically Important Non-Functional Plasma Enzymes

    • Amylase is elevated in acute pancreatitis
    • Creatine kinase increases in heart, brain, and skeletal muscle diseases
    • Lactate dehydrogenase is elevated in heart, liver, and blood diseases
    • Alanine transaminase is elevated in liver and heart diseases
    • Aspartate transaminase is elevated in liver and heart diseases
    • Acid phosphatase is elevated in prostate cancer
    • Alkaline phosphatase is elevated in obstructive liver diseases and bone diseases

    Enzymes as Diagnostic Markers

    • Enzyme activity (not concentration) is measured as IU/mL
    • 1 IU/mL equals the activity of an enzyme transforming 1 µmol of substrate/minute
    • Correlates with tissue damage
    • Predicts prognosis
    • Tissue-specific enzymes/isoenzymes reflect damage to the tissue

    Myocardial Infarction

    • Myocardial infarction (heart attack) can present with nausea, vomiting, sweating, pallor, anxiety, and crushing chest pain, and difficulty breathing
    • Diagnostic tools include cardiac enzymes (e.g., CK-MB, LDH, AST, Troponin I & T)

    Investigations (Cardiac Markers)

    • Values of markers like CK-MB, LDH, AST, Myoglobin, Troponin I & T
    • Abnormal activity/peak/duration/time period for the markers vary.

    Serum Enzymes in Myocardial Infarction

    • Specific enzymes start rising and peaking at specific times after MI onset (e.g., Creatine Kinase rising in 4-8 hours and peaking between 24 and 28 hours)
    • Various enzymes have different durations of rising and falling in blood.

    Types of Biochemical Markers for Myocardial Infarction

    • Cardiac enzymes (isoenzymes) : Total CK, CK-MB activity, CK-MB mass, LDH, AST
    • Cardiac proteins: Myoglobin, Troponins

    Cardiac Markers (Time Course)

    • Graph showing how different cardiac enzyme marker levels change over hours/days following myocardial infarction
    • Different cardiac markers have different patterns in blood after MI (rising hours and peak/duration varies)

    Cardiac Markers (Serum)

    • Graph showing different marker level in blood over different days from start of MI

    ECG

    • An ECG can show ST elevation during a myocardial infarction.

    Criteria for Ideal Markers of Myocardial Infarction

    • The ideal markers of myocardial infarction are specific, sensitive, prognostic, and persist for a duration allowing for diagnosis of delayed admission, reliable, simple, inexpensive, and quick.

    Cardiac Enzymes (Including Total CK and CK-MB)

    • Total CK is non-specific, but CK-MB is more specific; however, it is also present in skeletal muscles (less specific than cardiac troponin)
    • CK-MB appears in blood within 4 - 6 hours of MI onset and peaks in 12 - 24 hours.
    • CK-MB returns to normal levels after 2-3 days.

    Creatine Kinase (CK)

    • CK has three isoenzymes: CK-MM in skeletal muscle. CK-BB in brain and CK-MB in heart and skeletal muscle.
    • CK-MB was previously a very useful marker for MI diagnosis

    Lactate Dehydrogenase (LDH)

    • LDH is a tetramer with five isoenzymes, LDH1 and LDH2 predominates in heart
    • LDH appears in blood 18-16 hours after MI and peaks in 48 hours.
    • LDH usually remains elevated for 5-6 days or longer (up to 14 days)
    • LDH is a non-specific marker for other conditions like liver, lung, kidney, etc.

    Lactate Dehydrogenase (LDH) Isoenzymes

    • LDH isoenzymes have different tissue distributions (HHHH, HHHM, HHMM, HMMM, MMMM).
    • LDH1 (HHHH) is found prominently in the myocardium
    • Other LDH isoenzymes are in other tissues.

    Serum Aspartate Aminotransferase (AST)

    • AST is less specific for myocardial infarction than CK-MB.
    • It starts rising between 6-12 hours after a MI and peaks in 24-48 hours.

    Cardiac Troponins

    • Cardiac troponins are highly specific for myocardial injury; cTnI and cTnT are biomarkers
    • Appears in blood within 6 hours and peaks in 24 hours following MI
    • Stayes in the blood for at least 10 days or more

    Myoglobin (MB)

    • Myoglobin is a non-specific marker; it is released quickly by damaged muscle
    • Myoglobin rises early (within 1 hour following necrosis) and reaches peak in 4-12 hrs
    • It's elevated for 0-4 hrs
    • Limited/short time period in the blood
    • Muscle damage can lead to misdiagnosis

    Hepatic Enzymes

    • Jaundice, nausea, vomiting, fatigue, weakness
    • Elevated enzymes indicate liver damage
    • Alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase

    Serum Enzymes in Liver Diseases

    • Enzyme tests categorize into those detecting hepatocyte damage and those showing cholestasis
    • Aminotransferases are indicators of liver cell injury from acute hepatitis

    Enzymes that Reflect Cholestasis

    • Alkaline phosphatase, 5'-nucleotidase, and gamma-glutamyl transferase are elevated in cholestasis
    • Alkaline phosphatase & 5'-nucleotidase are found in hepatocytes
    • Gamma-glutamyl transferase found in endoplasmic reticulum and bile duct epithelial cells

    Levels of Liver Enzymes in Diseases

    • Rapid rise in transaminases (AST and ALT) occurs before bilirubin rise during viral hepatitis

    Liver Function Tests (LFTs)

    • LFTs assess liver function (e.g., Total protein, albumin, globulin, A/G ratio, Alkaline phosphatase, ALT, AST)
    • Specific patterns suggest hepatitis or cirrhosis

    Standard Liver Panel

    • Standard liver panel includes Albumin, Transaminases (ALT and AST), Alkaline phosphatase, Total bilirubin, Direct bilirubin, Gamma-glutamyl transpeptidase, 5' Nucleotidase, Lactate dehydrogenase, INR

    Serum Total Protein and A/G Ratio

    • Serum total protein is made of albumin and globulins (a1, a2, β, γ)
    • The A/G ratio (albumin/globulin) is an index of disease state, but it's not specific
    • Normal A/G ratio is 0.8-2.0

    Hepatic Enzymes (Detailed)

    • Includes enzymes like aspartate aminotransferase (AST or SGOT) for myocardial infarction, liver disease, or liver cell damage
    • Alanine aminotransferase (ALT or SGPT) for liver diseases, liver cell damage, or liver disease/biliary obstruction
    • Alkaline Phosphatase (ALP) for liver diseases, biliary obstruction, or osteoblastic bone disease.

    Lactate Dehydrogenase (LDH) (Detailed)

    • LDH is a tetrameric enzyme with five isoenzymes (HHHH, HHHM, HHMM, HMMM, MMMM) with primarily different tissue-specific distributions.
    • LDH is widespread in various tissues, including blood cells, heart muscle.
    • LDH is a marker to common injuries and diseases such as heart failure.

    Gamma-Glutamyl Transferase (GGT)

    • GGT is part of a system moving amino acids.
    • Important as it can help determine the reason for increased levels of alkaline phosphatase
    • Elevated GGT and ALP occur in biliary duct or some liver diseases but only ALP will be elevated in bone diseases.

    Serum Enzymes in Gastrointestinal (GI) Tract Diseases

    • Amylase is elevated within 24 hours in acute pancreatitis.
    • Further, elevated levels are also seen in perforated peptic ulcers and intestinal obstructions
    • Lipase is highly elevated in acute pancreatitis, perforated duodenal ulcers, and intestinal obstructions

    Serum Enzymes in Muscle Diseases

    • Creatine kinase and aspartate transferase are elevated with muscle diseases like muscle damage

    Markers of Muscle Damage

    • Creatine kinase (CK) is released by damaged muscle, and its concentration rises steadily for 12 hours, remains elevated for 1-3 days, and then falls.
    • Myoglobin has a short half-life.
    • Lactate dehydrogenase (LDH) is elevated
    • Other markers of muscle damage (aldolase, troponin, carbonic anhydrase)

    Enzymes as Tumor Markers

    • Enzymes like serum acid phosphatase, serum alkaline phosphatase, serum LDH, B-glucuronidase, leucine amino peptidase (LAP), neuron-specific enolase can help in identifying cancers

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    Description

    This quiz focuses on the various enzymes critical for diagnosing myocardial infarction and understanding tissue damage. It covers significant markers, their roles, and implications in clinical diagnostics. Test your knowledge on enzymes such as LDH, Myoglobin, and others commonly involved in cardiac and pancreatic conditions.

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