Presentation on theme: "Biomarkers in Cardiovascular System"— Presentation transcript:
1Biomarkers in Cardiovascular System Dr. Bibi Kulsoom
2Cardiovascular Biomarkers KULSOOMCardioBloodSubstances thatLead toInvolved in process ofReleased as a result ofcardiovascular diseaseAppearance of abnormal substancesand/ORed level of normal substancesDetected ormeasuredin blood as a markerSamplingVascular
5Creatine (Phospho) Kinase (CK, CPK) KULSOOMTissue location & Isoenzymes : Three isoenzymes foundCK-MM (97%): found in skeletal musclesCK-MB(2%): found in cardiac musclesCK-BB(traces): found in brain cellsFunction:Creatine phosphate quickly regenerates ATP in the tissues.Arginine + Glycine + Methionine Creatine.ATPADPCreatineCreatine phosphateCreatine kinase
6Creatine (Phospho) Kinase (CK, CPK) KULSOOMMain conditions with raised levels of CK-MB is heart tissue damage(e.g. myocardial infarction (MI)).A total CK level will reflect the presence of tissue damage but, specific isoenzyme (CK-MB) can identify the underlying cause or its location.Normal levels of total CK =30 to 180 U/L (units per liter).CK-MB fraction: 0-5% of CK, CK-MB activity: 0-15%
7Lactate Dehydrogenase KULSOOMTissue location & Isoenzyme: five isoezymes mainly distributed as follows:LDH-1: heart muscle and red blood cells.LDH-2: white blood cells.LDH-3: lungs.LDH-4: kidney, placenta, and pancreas.LDH-5 : liver and skeletal muscle.
8Lactate Dehydrogenase KULSOOMFunction:Main conditions with abnormal levels: tissue damage (e.g. MI), cancers, kidney disease, and liver disease. LDH1 is raised in heart tissue damage.Normal levels: U/LNAD+NADHLactatePyruvateLactate dehydrogenase
9Lactate Dehydrogenase KULSOOMA total LDH level will reflect the presence of tissue damage but, by itself, it cannot be used to identify the underlying cause or its location.LDH too has been superseded by the newer markers and should not be included in the ‘cardiac profile’. But LDH might be used as a marker of cardiac dysfunction where a troponin assay is not available.
10Aspartate Transaminase (AST) KULSOOMOne of the oldest markers of MI.AST (+ CK and LDH) is still in use.Levels can be elevated in liver diseases as well.Little value as a marker of cardiac dysfunction and has been superseded by newer markers.
12Troponins KULSOOM Troponin Tropomyosin Actin I C T
13Troponins Tissue location & types: cytoplasm of the muscle cells KULSOOMTissue location & types: cytoplasm of the muscle cellsThree types, which regulate muscle contraction.Troponin C (TnC) binds to calcium ions to produce a conformational change in TnITroponin I (TnI) binds to actin in thin myofilaments to hold the troponin-tropomyosin complex in place.Troponin T (TnT) binds to the tropomyosin strand forming a complex.
14Troponin I & TKULSOOMTnT & TnI are specific (different) for skeletal & heart muscle. They are measured in the blood to differentiate between unstable angina and myocardial infarction (heart attack) in patients with chest pain
15MyoglobinKULSOOMA protein which stores oxygen inside muscle tissue (cardiac, skeletal & smooth).is the earliest biological marker of myocardial necrosis.This is now replaced by troponin, the more specific one.has the advantage of responding very rapidly, rising and falling earlier than CK-MB or troponin.Raised in muscle damage (e.g. MI, skeletal muscle damage).Normal levels in blood: < 80 ng/mL.
16Biomarkers Released in Blood after Myocardial Infarction KULSOOMMyoglobinTotal CKLDHCK-MBTroponin I
17Biomarkers Released in Blood after Myocardial Infarction KULSOOMTroponin TTroponin ICK-MB & Total CKMyoglobin
18Biomarkers Released in Blood after Myocardial Infarction KULSOOM
21The normal levels of homocysteine should be less than 10 micromoles/L. Elevated Homocysteine Levels Increase the Risk for Cardiovascular DiseaseKULSOOM32Arterial wall cells proliferate in an effort to heal the lesion, leading to plaque formation.1Circulating monocytes rush to the site of injury causing inflammation.Homocysteine injures the arterial wall and fatty substances accumulate.The normal levels of homocysteine should be less than 10 micromoles/L.
22C-reactive Protein (CRP), Fibrinogen & Amyloid A protein KULSOOM C-reactive protein Fibrinogen Amyloid A proteinActivation certain genesInflammation in any part of the bodyIL-6Increased risk of cardiovascular Disease C-reactive protein Fibrinogen Amyloid A proteinInflammation in atherosclerotic plaqueMarkers of inflammationFavor more inflammationMore coagulobility
23C-reactive Protein (CRP), Fibrinogen & Amyloid A protein KULSOOMCRP is a protein present in the blood (secreted by liver) that shows the presence of inflammation in the body. Atherosclerosis is an inflammatory process. CRP can be a marker of atherosclerosis and myocardial infarction.Fibrinogen is a protein present in the blood that shows the predisposition to thrombus formation. Atherosclerosis can rupture and lead to thrombus formation which is the collection of fibrin meshwork of and platelets aggregation. Hence it can be a marker of myocardial infarction.Amyloid A a protein in the blood secreted by liver in response to the presence of inflammation in the body. Amyloid A can be a marker of atherosclerosis.
24Atrial & Brain Natriuretic Peptide(ANP) KULSOOMAtrial natriuretic peptide (ANP):Secreted by atrial muscles in response to atrial distention due to any cause.Normal levels: p mol/LBrain natriuretic peptide(BNP):Secreted by ventricular muscles stretching.Normal values of BNP: <50 pg/mlBNP: >100 pg/ml suggests congestive heart failure.Thank You