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Cardiac EnzymesOrdered for patients c/o chest pain and suspected AMICE’s are drawn in sets of three 6 to 8 hours apart Sometimes initial results are negativeCK-MB & Troponins are released within hours of a cardiac event
CPK Creatine Kinase TotalRises within 3 - 12 hours after an AMI Peak @ 24 hoursReturn to normal within 48 – 72 hours (Davis, 2004, p. 102)
Cardiac Enzymes CPK 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)
CK-MB Creatine Kinase IsoenzymeRise within 3 - 12 hours after an AMI Peak @ 24 hours (6x > normal)Return to normal within 48 – 72 hours (Moser & Riegel, 2008, p. 792)
CK-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)
Troponin IRises within 3 – 12 hours of an AMI Peaks at 24 hoursNormalizes within 5 – 10 days Preferred cardiac enzyme in diagnosis of an AMI (Moser & Riegel, 2008, p. 792)
Troponin IExcellent sensitivity & specificity • Point of Care Testing Available• Not influenced by skeletal muscle disease or renal disease (Moser & Riegel, 2008, p. 792)
CE’s & Critical Values Lab 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
Cardiac EnzymesPatients with elevated CE’s usuallyundergo a stress test and/or cardiac catheterization for furtherinvestigation of cause of chest pain.
ReferencesDavis, 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