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Basic lab data interpretation in cardiac conditions
- 2. Contoso Pharmaceuticals page 2 • Clinical laboratory test results are very important parameter in diagnosis, monitoring and screening especially in cardiac conditions. • It is therefore imperative for patient care and safety that we as clinicians become familiar with the interpretation of the test results. INTRODUCTION
- 3. Contoso Pharmaceuticals ClinicalLaboratoryStudies Serum Enzymes Blood Lipids Blood Cell Count Coagulation Profile Electrolytes Others page 3 The clinical laboratory studies taken into consideration for the evaluation of cardiac conditions are:
- 4. Contoso Pharmaceuticals page 4 • The markers that are diagnostic of cardiac injury includes: 1. Creatine phosphokinase (CPK) 2. Lactic dehydrogenase (LDH) 3. Troponin 4. Aspartate aminotransferase (AST) 5. Myoglobin 6. Carbonic anhydrase III SERUMENZYMES ANDMARKERS Evaluation of specific serum enzyme levels and cardiac protein markers contributes to a definitive diagnosis of myocardial necrosis.
- 5. Contoso Pharmaceuticals page 5 • The normal value of creatine phosphokinase is as follows: 1. Males : 15 – 160 U/L 2. Females : 15 – 130 U/L • More specifically, Creatine Phosphokinase (CPK) has three isoenzymes which are differentiated by their tissue distribution. • These isoenzymes are: 1. CPK – MB 2. CPK – BB 3. CPK – MM
- 6. Contoso Pharmaceuticals Out of all the isoenzymes of creatine phosphokinase (CPK), the isoenzyme that is taken into consideration for the cardiac conditions is Creatine Phosphokinase – Myocardial Band (CPK – MB). The normal value of CPK- MB is 0 – 3 % of total CPK. CPK-MB CPK- MB fraction is most conclusive for myocardial injury. Its increased level indicates: 1. Necrosis of myocardial cell. 2. Acute MI 3. PTCA 4. Cardioversion 5. Pericarditis 6. Myocarditis 7. Prolonged SVT CPK-BB CPK – BB fraction is the most conclusive for brain tissue injury. CPK-MM CPK – MM fraction is the most conclusive for skeleton muscle damage. page 6
- 7. Contoso Pharmaceuticals page 7 • The normal value of Lactic dehydrogenase (LDH) is 100 – 250 mU / mL. • The increased levels of LDH is seen in following conditions: 1. Acute MI 2. Cardiac Surgery 3. Prosthetic HeartValve. • LDH has five isoenzymes: 1. LDH1 : (H4) 2. LDH2 : (H3M1) 3. LDH3 : (H2M2) 4. LDH4 : (H1M3) 5. LDH5 : (M4) • If the LDH1 / LDH2 > 1.0 it indicates recent myocardial infarction. • This ratio level starts to rise at 12 – 48 hours. LacticDehydrogenase
- 8. Contoso Pharmaceuticals page 8 • The troponin tests consists of two major proteins: 1. Troponin I 2. TroponinT • The normal levels of these proteins are: 1. Troponin I : < 0.1 µg / L 2. TroponinT : < 0.01 µg / L • Increase in the levels of troponin proteins is suggestive of : 1. Acute MI 2. Angina 3. Coronary Syndrome 4. Cardiac Surgery 5. ElectricalCountershock 6. Myocarditis 7. Heart Failure 8. Cardiomyopathy 9. Percutaneous Coronary Interventions Troponin
- 9. Contoso Pharmaceuticals Otherserumenzymesandmarkerstakenintoconsiderationare: Aspartate Amino- Transferase Normal Levels of AST is : 5 – 30 U / L Its level increases in Acute MI Myoglobin Normal Level of Myoglobin is: ≤ 90 ng / mL Its level increases in Acute MI and Cardiac Surgeries. Carbonic Anhydrase III The myoglobin value / Carbonic anhydrase III (Myo/CAIII) is: <3.2 page 9
- 12. Contoso Pharmaceuticals page 12 • Elevation in blood lipid levels (hyperlipidemia) is considered a major risk factor contributing to Coronary Artery Disease (CAD). • The factors taken into consideration are as follows: 1. Total Cholesterol 2. High Density Lipoproteins (HDL) 3. Low Density Lipoproteins (LDL) 4. Triglycerides BLOOD LIPIDS
- 16. Contoso Pharmaceuticals page 16 • The physical therapist should evaluate the complete blood cell count for five components: 1. Red Blood Cells (RBC) 2. Hemoglobin 3. Hematocrit 4. White Blood Cells (WBC) 5. Platelets BloodCellCount
- 17. Contoso Pharmaceuticals Males 4.6 – 6.2 x 106 /µL Females 4.2 – 5.4 x 106 /µL Males 13.5 - 18 g/dL Females 12 - 16 g/dL page 17 BloodCells RED BLOOD CELLS HEMO - GLOBIN
- 18. Contoso Pharmaceuticals HEMATOCRIT NormalValue: Males : 40 – 54 % Females : 38 – 47 % WHITE BLOOD CELLS NormalValue: 4500 – 11,000 / µL of whole blood PLATELETS NormalValue: 3,00,000 / µL page 18 •Increase in the complete blood cell count is indicative of: 1. COPD 2. CHF 3. Cardiovascular disease 4. Congenital Heart Disease 5. Heart Attack • Particularly after coronary artery bypass graft surgery, patients will demonstrate decreased Hematocrit and Hemoglobin values and this may be symptomatic with activity because of low oxygen carrying capacity.
- 19. Contoso Pharmaceuticals page 19 • Coagulation profiles have become an important component of the patient’s medical record because of the use of the thrombolytic agents to dissolve clots in the early stages of myocardial infarction. • Coagulation of the blood is measured through: 1. ProthrombinTime (PT) 2. PartialThromboplastin Time (PTT) • Their normal values are as follow: 1. PT : 11.6 – 13.0 sec 2. PTT : 21.5 – 34.1 sec • Prolonged PT and PTT have been associated with a high hematocrit levels. • Decreased PT and PTT is indicative of : 1. DIC CoagulationProfile
- 20. Contoso Pharmaceuticals page 20 • All electrolyte levels should be observed when evaluating the laboratory results because disturbances in the electrolytes may affect the patient’s performance. • The electrolytes taken into consideration are: 1. Bicarbonate (HCO3 -) : 22 – 26 mmol / L 2. Calcium (Ca2+) : 2.15 – 2.50 mmol / L 3. Chloride (Cl-) : 100 – 108 mmol / L 4. Magnesium (Mg+) : 0.60 – 1.05 mmol / L 5. Potassium (K+) : 3.5 – 5.0 mmol / L • Dangerously low levels of potassium (< 3.5 mmol / L) can cause serious life threatening arrhythmias. • Dangerously high levels of potassium (> 5.0 mmol / L) can affect the contractility of myocardium. • Abnormal increase in electrolytes can lead to: 1. Heart Attack 2. Cardiovascular Disease 3. Angina 4. Congestive Heart Failure ELECTROLYTES
- 21. Contoso Pharmaceuticals page 21 • Other laboratory values may be abnormal but not usually indicative of cardiac dysfunction and instead may be related to other co-morbidities. • Abnormal laboratory values should be investigated to assess for co-morbidity and any effect on the cardiac system. • The factors that should be assessed are as follow: 1. Blood Urea Nitrogen (BUN) 2. Glucose 3. Albumin 4. Homocysteine 5. C – Reactive Protein (CRP) 6. Creatinine OTHERFACTORS
- 22. Contoso Pharmaceuticals BLOOD UREA NITROGEN • NormalValue: o 8 – 18 mg / dL • Increased blood urea nitrogen (BUN) level is indicative of kidney dysfunction occurring due to conditions like: 1. Congestive Heart Failure 2. Recent Heart Attack GLUCOSE • NormalValue: o 70 – 110 mg / dL • Increased urine glucose is indicative of congestive heart failure. • This test is not suitable for detection of congestive heart failure as some people naturally leak glucose in their urine even when the blood levels are normal. ALBUMIN • NormalValue: o > 2.5 g • A low level of serum albumin is seen in plasma volume expansion due to congestive heart failure page 22
- 23. Contoso Pharmaceuticals HOMOCYSTEINE • NormalValue: < 16.2 µmol / L • Recently elevated blood levels of homocysteine have been identified as an independent risk factor for the development of coronary heart disease. C-REACTIVE PROTEIN • NormalValue: 5 mg / L • Inflammatory marker CRP have recently been related to increased risk for Coronary Artery Disease (CAD). • Males with CRP levels in the highest quartile may have a fivefold increase in the risk of developing myocardial infarction. CREATININE • NormalValue: 0.6 – 1.2 mg / dL • Decreased creatinine level in blood is indicative of reduced blood flow to kidney due to congestive heart failure page 23
- 24. Contoso Pharmaceuticals REFERENCE: Essentials of Cardiopulmonary PhysicalTherapy (Second Edition) - Hillegass and Sadowsky Cardiovascular and Pulmonary PhysicalTherapy (Second Edition) - JoanneWatchie page 24
- 25. Contoso Pharmaceuticals page 25 ThankYou Florence Macwan Roll No. : 8 FinalYear B.P.T. Sarvoday College of Physiotherapy