cardiac disease
TRANSCRIPT
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CARDIAC DISEASECLINICAL BIOCHEMISTRY
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Learning Objectives
• Explain the etiology of Myocardial infarction (MI).
• List out the symptoms of MI.• Elaborate the tests to investigate the disease.
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Myocardial Infarction
• Heart attack= MI= death of heart muscle from the sudden blockage of a coronary artery by blood clot
• Blockage; injury; chest pain & pressure; muscle death; scar tissue.
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Etiology
• Atherosclerosis with occlusive or partially occlusive thrombus formation
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Symptoms of MI
1)Chest painSqueezing, aching, burning or sharp painMore than 30 min: infarctionAssociated with nausea, vomiting, dyspnea,
fatigue or palpitationsAtypical chest pain common in diabetes and
elderly patients
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2)Shortness of breathAnginal equivalent or symptom of heart
failureDue to elevated end-diastolic pressure; lead
to elevated pulmonary pressure
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3)Atypical presentationsCommon and lead to misdiagnosesAbdominal discomfort or jaw pain may
presentElderly patient may present with altered
mental statusWomen present more common atypical
symptoms
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Physical Examination of MI
• Low grade fever• Hypo or hypertension• 4th heart sound (S4) may be heard• Dyskinetic cardiac bulge• Systolic murmur can be heard• Cool, clammy skin and diaphoresis• Signs of CHF
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Risk Factors
1)Non modifiable risk factorsFamily history of premature coronary heart
disease
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2) Modifiable risk factors Smoking Diabetes mellitus Hypertension Dyslipidemia Obesity Sedentary life Psychosocial stress Poor oral hygiene
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3) Non atherosclerotic causes Vasculitis Coronary emboli Congenital coronary anomalies Coronary trauma Coronary spasm Drugs Factors that increase O2 requirement & decrease O2 delivery
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Lab Investigation
• Cardiac enzymes• Troponin levels• Myoglobin levels• Lipid profile• ECG
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Cardiac Enzymes
• Creatine kinase: 3 isoenzymes• CK-MB: mainly in heart• Serial measurement of CK-MB for diagnosis MI• CK-MB: increase within 3-12 hours of onset, peak values
within 24 hours, return baseline after 48-72 hours• High sensitivity & specificity (but not as high as Trop T)
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Troponin
• Greater sensitivity & specificity• Role in diagnostic and prognostic• Positive troponin levels virtually diagnostic of
MI• Trop T: increase within 3-12 hours from onset,
peak at 24-48 hours, return baseline over 5-14 days
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Myoglobin
• Urine myoglobin: rise within 1-4 hours from onset
• High sensitive but not specific• Useful in early detection of MI in the ED
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Treatment of MI
• Restoration balance between oxygen supply and demand
• Pain relief• Prevent and treat complications
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QUESTIONS :
• Discuss in a group;(1) Information about Myocardial infarction.
Discussion must include the etiology, symptoms, physical examination and risk factor.(2) Elaborate the tests to investigate the disease.
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