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Diagnosis of AMI

Diagnosis of AMI. Typical symptoms (may not be present) Distinctive ECG (may not be present) Abnormal blood tests Troponin-I “CK,” “CPK,” or “CK-Mb”. Definition: unstable angina.

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Diagnosis of AMI

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  1. Diagnosis of AMI • Typical symptoms (may not be present) • Distinctive ECG (may not be present) • Abnormal blood tests • Troponin-I • “CK,” “CPK,” or “CK-Mb”

  2. Definition: unstable angina • Unstable angina—an acute process of myocardial ischemiathat is not of sufficient severity and duration to resultin myocardial necrosis. • Donot release biomarkers indicative of myocardial necrosisinto the blood.

  3. REQUISITI PER UN MARCATORE DI LESIONE DEL MIOCARDIO “IDEALE” • Presente in elevate concentrazioni nel muscolo cardiaco • Contenuto unicamente nella cellula miocardica • (SPECIFICITA’ ASSOLUTA) • Assenza dal circolo in condizioni di normalità • (ESTREMAMENTE SENSIBILE E PRECISO) • Rilasciato dal muscolo cardiaco danneggiato rapidamente • in maniera completa ed in quantita’ proporzionale al • danno miocardico • Rilevabile nel plasma in una finestra diagnostica utile a • porre diagnosi sia precocemente che tardivamente • Validato dai trials clinici • Saggio ampiamente disponibile e poco costoso

  4. A causa della loro scarsa sensibilita’ e specificita’, le determinazioni di aspartato amminotransferasi (AST), lattato deidrogenasi (LDH) totale e suoi isoenzimi, CK totale ed attivita’ catalitica del suo isoenzima MB dovrebbero essere considerate come obsolete. Panteghini M et al. G Ital Cardiol 1999;29:810

  5. Tools: Cardiac Markers for AMI Diagnosis Creatine Kinase MB isoenzyme (CK-MB) Myocardial specific. 4-10 hrs to achieve diagnostic performance. 2-3 days to return to normal. Myoglobin 2-3 hrs to achieve diagnostic performance. 24 hrs to return to normal. Not specific, abundant in skeletal muscle. Troponin T or I (TnT, TnI) Myocardiac specific. Up to 12 hrs to achieve diagnostic performance. Several days to return to normal.

  6. Myoglobin • Rapid rise • Non-specific. • Cannot be used alone to confirm MI

  7. CPK-MB • 15% of cardiac CPK, small amount in skeletal muscle • MB-Mass Validated as marker for MI. However: • Can increase after muscle injury, muscular diseases. • Can be found in tongue, intestine, diaphragm, uterus, prostate.

  8. Le Troponine cardiache Sono costituite da un eterotrimero suddiviso in 3 sub-unità : • Troponina C : 18 kD deputata a legare ioni Ca++ • Troponina I : 22 kD con funzione inibitoria • Troponina T : 37 kD con funzione di legame alla tropomiosina

  9. Figure 1. Plot of the appearance of cardiac markers in blood vs time after onset of symptoms. Peak A, early release of myoglobin or CK-MB isoforms after AMI; peak B, cardiac troponin after AMI; peak C, CK-MB after AMI; peak D, cardiac troponin after unstable angina. Data are plotted on a relative scale, where 1.0 is set at the AMI cutoff concentration.

  10. New and old diagnostic criteria for MI WHO Criteria for Diagnosis of MI ESC / ACC Recommendations for diagnosis of MI Chest pain Evidence of myocardial damage as assessed by pathologic exam, ECG or imaging modality Elevated cardiac markers Trop or CK and CKMB 2 of 3 One of the following ECG changes Serum markers Alpert et al - ACC Consensus. JACC 2000; 36: 959 - 969

  11. Cardiac Analyzer 2nd and 3rd Specimens 6hrs and 12hrs Second or third specimen Measure CKMB Previous Troponin > 99th percentile Delta CKMB > 20% Yes No Measure troponin Yes Continue test algorithm Troponin > 3.0 ng/ml No Measure troponin Yes Cancel remaining tests

  12. The Future • Early indicators of plaque instability • Early indicators of thrombotic activity • Markers for IIb/IIIa sensitivity • Indicators of cytokine activation

  13. Technology in the Future : Family of Near- Patient Diagnostic Sensors

  14. FORUM GoTo: SOURCE @ Stanford University | Search | No Clone Report | Help | ACTIVATE: SMART analysis Confidently predicted domains, repeats, motifs and features: UniGene Cluster Hs .112669 Homo sapiens SELECTED PROTEIN SIMILARITIES 9/23 82.6 %: cytoplasmic 13.0 %: nuclear 4.3 %: peroxisomal EMBL/Genbank->Unigene mapping provided by RZPD http://www.rzpd.de EBI-Hinxton-"Uniprot-Swissprot-TrEMBL" database GoTo: SOSUI analysisThis amino acid sequence is of a SOLUBLE PROTEIN.

  15. Tools: FABP in AMI Diagnosis FABP Characteristics Small cytoplasmic protein, abundant in heart and muscle. Cardiac specific isoforms Normal levels below 1ng/ml. Most sensitive early cardiac marker. <3 hrs to achieve diagnostic performance. 12-24 hrs to return to normal.

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