cardiac biomarkers - bmh tele
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Cardiac Biomarkers in ACSCardiac Biomarkers in ACS
Natalie Bermudez, RN, BSN, MS
Clinical Educator for Cardiac Telemetry
Telemetry
Course
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Cardiac EnzymesCardiac EnzymesA.K.A. ACP (Acute Cardiac Profile)
Normal Ranges:CPK Total: 26 – 192
CK-MB: 0 – 3.60
Troponin I: 0 – 0.099Normal < 0.10
Borderline 0.10 – 0.50Abnormal (Critical Value) > 0.50
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Cardiac EnzymesCardiac EnzymesOrdered for patients c/o chest pain
and suspected AMI
CE’s are drawn in sets of three 6 to 8 hours apart
Sometimes initial results are negative
CK-MB & Troponins are released within hours of a cardiac event
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CPKCPKCreatine Kinase Total
Rises within 3 - 12 hours after an AMI
Peak @ 24 hours
Return to normal within 48 – 72 hours
(Davis, 2004, p. 102)
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Cardiac EnzymesCardiac EnzymesCPKCPK
Creatine Kinase Total
• Most facilities have the ability to measure this lab
• Highly sensitive for MI diagnosis but not very specific (many false
negatives)• Should not be the sole lab value used
to confirm diagnosis(Davis, 2004, p. 102)
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CK-MBCK-MBCreatine Kinase Isoenzyme
Rise within 3 - 12 hours after an AMI
Peak @ 24 hours (6x > normal)
Return to normal within 48 – 72 hours
(Moser & Riegel, 2008, p. 792)
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CK-MBCK-MB• Readily available
• Point of Care Testing available• Highly sensitive but not as
specific as other tests• May be falsely elevated by trauma, surgery, hypothermia, DKA, seizures, intramuscular
injections, stroke, or strenuous exercise
(Moser & Riegel, 2008, p. 792)
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Troponin ITroponin IRises within 3 – 12 hours of an
AMI Peaks at 24 hours
Normalizes within 5 – 10 days
Preferred cardiac enzyme in diagnosis of an AMI
(Moser & Riegel, 2008, p. 792)
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Troponin ITroponin IExcellent sensitivity & specificity
• Point of Care Testing Available
• Not influenced by skeletal muscle disease or renal disease
(Moser & Riegel, 2008, p. 792)
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CE’s & Critical ValuesCE’s & Critical ValuesLab will call nursing for critical lab
values
Physician needs to be notified immediately for Troponin > 0.50
Document in the “MD Notification & Critical Values” structured
note in eCOS
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Cardiac EnzymesCardiac Enzymes
Patients with elevated CE’s usually undergo a stress test and/or cardiac catheterization
for further investigation of cause of chest pain.
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ReferencesReferencesDavis, L. (2004). Cardiovascular nursing secrets. St. Louis, MO:
Elsevier Mosby.
Kee, J. L. (2005). Laboratory and diagnostic tests with nursing implications (7th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
Kee, J. L. & Paulanka, B. J. (2000). Handbook of fluid, electrolyte, and acid-base imbalances. Scarborough, Canada: Delmar Publishers.
Moser, D. K., & Riegel, B. (2008). Cardiac nursing: A compnion to braunwald’s heart disease. St. Louis, MO: Saunders Elsevier.
Smeltzer, S. C. et al. (2008). Brunner and suddarth’s textbook of medical-surgical nursing (11th ed.). Philadelphia, PA: Lippincott Williams and Wilkins.
Taber’s On-Line Medical Dictionary