Cardiac biomarkers are of great importance in the timely, accurate diagnosis and management of acute coronary syndrome as well as the prognosis. Diagnosis in the golden period is of utmost importance to institute therapy at the earliest and possibly reverse the myocardial damage. Cardiac biomarkers are also a powerful tool for triaging. Among the many biomarkers, the earliest examined were the myocardial enzymes, several myocardial proteins, peptides, and many other molecules.

1. CARDIAC
BIOMARKERS
BY- MAYANK SAGAR

2. WHAT ARE BIOMARKERS?
• Biomarkers are Substances which are present in body normally
in very low concentrations, but during certain conditions like
inflammation, necrosis & in cancers, they are highly elevated in
blood indicating disorder.
• They helps in diagnosis of disease & hence are of great clinical
use.
• Ideal biomarker should detect disease at the earliest & should
have high sensitivity & specificity.

3. WHEN CARDIAC BIOMARKERS ARE
PERFORMED
• Chest pain
• Suspecious ECG
• History of mycardial infaction
• Patients with Hypotension & dyspnea
• Unstable angina

4. CLINICAL SIGNIFICANCE OF CARDIAC
BIOMARKERS
1. Detection of Acute myocardial infarction at the earliest.
2. Detection of congestive heart failure.
3. Detect myocardial ischemia at the earliest.
4. Monitor progression of heart.
5. Predict the risk of cardiac dysfunction.

5. DIFFERENT CARDIAC BIOMARKERS
1. CK-MB
2. Cardiac troponin I & cardiac troponin T
3. Brain natriuretic peptide (BNP)
4. Myoglobin
5. Ichemia modified albumin

6. CREATINE KINASE (CK)
• Normal value- 15-100U/L
• CK value is increased in myocardial infarction.
• CK-MB rises within 3-6 hours of infaction.
• Very helpful in cases where ECG is suspicious.
• CK constist of three isoenzymes CK-MM , CK-MB& CK-BB
• CK-MM has least electrophoretic mobility & CK-Bb Has
maximum electrophoretic mobility.

7. CARDIAC TROPONIN I (CTI)
• These are not true enzyme.
• Specific marker for myocardial infaction.
• Relesed in blood within 4 hours of infaction ,peak
concentrations is 14-24hours & remain elevated for 3-5days
after infaction.
• It’s not elevated during muscle injury.

8. CARDIAC TROPONIN T (TNT)
• Serum levels increase within 6hours of infarction & peak is
achieved at 72hour & Them they are elevated for about 10-14
days post infarction.
• Elevation of Trop T indicated , a person may have a risk of
having an adverse cardiac event.

9. BRAIN NATRIURETIC PEPTIDE (BNP)
• Natriuretic family consists of 3 peptides, Atrial natriuretic
peptide (ANP), Brain natriuretic peptide (BNP) & C type
natriuretic peptide (CNP)
• ANP is produced in cardiac atria
• BNP is produced mainly in cardiac ventricles.
• Pro-BNP is cleavaged into active BNP & an inactive peptide.
• All these natriuretic peptide act against exess salt & water
retention.
• Patients with congestive heart failure have high concentration
of ANP& BNP, high concentration BPN predict poor long term

10. MYOGLOBIN
• Raised after myocardial infaction, it rises very fast compared to
other markers.
• It’s not specific & rises on certain other occasions such as
muscular injury.
• A negative value will exclude infaction & it’s helpful in early
hours of chest pain.

11. ISCHEMIA MODIFIED ALBUMIN
• Myocardial ischemia alters N-terminal of albumin reducing the
ability of cobalt to bind with albumin.
• Drawback is it has low specificity , hence generating high
numbers of faulse positive.
• Negative value rules out possibility of MI.

12. REFERENCES
• Bernstein L Cardiac-Related Creatine Kinase Isoenzyme MB. Pathology
Outlines 2017.
• Bhakthavatsala Reddy C, Cyriac C, Desle HB. Role of “ischemia modified albumin”
(IMA) in acute coronary syndromes. Indian Heart J 2014.
• Wang TJ, Wollert KC, Larson MG, et al. Prognostic utility of novel biomarkers of
cardiovascular stress: the Framingham Heart Study. Circulation 2012;126(13).
• Zhu Y, Lin Y, Yan W, et al. Novel biomarker microRNAs for subtyping of acute
coronary syndrome: a bioinformatics approach. BioMed Res Int 2016.