Cardiac function tests are used to determine if there has been damage to cardiac tissue by measuring certain enzymes, proteins, lipids, and ratios that are released after a cardiac event. The tests outlined in the document include creatine kinase (CK), CK-MB, lactate dehydrogenase (LDH), aspartate transaminase (AST), cardiac troponins I and T, myoglobin, lipid profile measurements of cholesterol, triglycerides, HDL, LDL, VLDL and their ratios, and apolipoproteins A1 and B. These markers provide information to help diagnose conditions like myocardial infarction, coronary artery disease, and atherosclerosis.

1. Cardiac function
test
By : zalak , jemisha , namrta , priyanka ,
kalyani , dipika

2. Introduction
o Cardiac function tests used to determine
whether there has been any cardiac tissue
damage.
o This tests performed to help diagnose a
cardiac disease.
o Myocardial infarction
o Coronary artery disease
o Atherosclerosis

3. Cardiac function tests include
1. CK (Creatine kinase)
2. CK-MB
3. LDH (Lactate Dehydrogenase)
4. SGOT
5. Troponin
6. Myoglobin
7. Lipid Profile :
1. Cholesterol
2. Triglyceride
3. HDL-cholesterol
4. LDL-cholesterol
5. VLDL-cholesterol
8. LDL/HDL ratio
9. LDL/Total cholesterol
10. Apolipoprotein – A1
11. Apolipoprotein - B

4. 1. CK (CREATINE KINASE)
Principle:

5. Method : Increasing Kinetic
Biological reference range :- 25-120 U/L
Clinical Significance:
 CPK ( Creatine phosphokinase ) activity is
increase in
 Brain (CK-BB = 1%)
 Cerebro-vascular stroke
 heart muscle (CK-MB = 5-10%)
 Myocardial infarction
 Acute coroary syndrome
 skeletal muscle. (CK-MM= 85%)
 Crush injury
 Myopathy
 Polymyositis

6. 2. CK-MB
Principle:
 measurement of CK activity in the presence of an
antibody to CK-M monomer.
 This antibody completely inhibits the activity of CK-MM
& half of the activity of CK-MB while not affecting the B
subunit activity of CK-MB &CK-BB.
Method :
• Increasing Kinetic UV method

7. Biological reference range :-0 - 25 IU/L
Significance:
• CK-MB present only in cardiac tissue
• So…Specific for diagnosis of cardiac
disease

9. CK-2 & CK-3 in normal subject &
After 24 hours of Myocardial Infarction
Creatine Kinase isoenzymes in blood

10. 3. LDH (lactate dehydrogenase)
Principle:
 Lactate dehydrogenase catalyses the conversion of
pyruvate to lactate.
Lactate dehydrogenase
Lactate + NAD+ ---------------- Pyruvate + NADH + H+
The rate of NADH+ formation is measured by 340nm
filter.
It is direactly propotional to serum LDH activity.

11. Method :
• IFCC method (Lactate to Pyruvate method )
• Increasing kinetic
Biological reference range :- 70-240 IU/L
Clinical significance :
 RBC
 Malaria
 Sickle cell anemia
 hemolytic disorder
 Liver
 Viral Hepatitis
 Liver malgnancy
 Alcoholic liver disease
 Cardiac tissue
 Myocardial infarction
 Skeletal muscle
 Muscular distrophy
 Crush injury

12. LDH Iso-enzyme

13. 4. GOT ( AST )
Principle:
L-Aspartate+α Ketoglutarate
GOT(with P5P)
Oxaloacetate + LGlutamate
Oxaloacetate + NADH + H+
MDH
Malate + NAD+
AST = Aspartate Transaminase
GOT = Glutamic Oxalate Transaminase
The rate of NADH to NAD is measured as a decrease in absorbance at 340
nm.
 Method:
 IFCC method with / without Pyridoxal 5 phosphate
(P5P)
 Decrease UV - kinetic

14.  Biological reference range:
 15 – 45 IU/L
 Clinical significance:
1. Acute hepatocellular damage
2. Myocardial infarction
3. Congestive heart failure.
4. Biliary tract obstruction
5. Cholicyctisis

15. 5. Cardiac Troponin – I &
Cardiac Troponin - T
 The troponin complex consists of 3 components;
 Troponin C(calcium binding)
 Troponin I(actomysin ATPase inhibitary element)
 Troponin T(tropomyosin binding element).
 Measured by
 ELISA or RIA techniques.
 Immunoturbidometry
 Immuno-diffusion method
 Serum level of troponin T increases within 6 hrs of
myocardial infarction.
 Troponin I is released into the blood within 4 hrs after
the onset of cardiac symtoms.

16. Biological reference range:-
Troponin I : 0.04 – 40 ng/ml.
Troponin T : 0.01 – 25 ng/ml.
Significance:
For diagnosis of myocardial damage.
 Most sensitive
 Specific test
 Early detectable.
 It used mainly in the diagnosis of chest-pain
patients when ECG is normal.

17. Cardiac Marker

18. Cardiac Marker
Plasma Enzymes Changes
After Myocardial Infarction

19. 6. myoglobin
 O2 binding protein in skeletal and cardiac muscles
 Released mailnly from skeletal muscle damaged
tissues.
 Its level rises more rapidly than C-troponin and CK-
MB.
Principle:
 RIA (Radio-Immuno Assay )
 ELISA (Enzyme Link Immuno-Sorbant Assay)
 Chemiluminescence.

20. Biological reference range:-
25 – 72 ng/ml
Significance:
• Major skeletal muscular injury
• Crush injury
• Burns

21. 7. Lipid profile:
1. Total Cholesterol
2. Triglyceride
3. HDL-cholesterol ( High Density Lipoprotein )
4. LDL-cholesterol ( Low Density Lipoprotein )
5. VLDL-cholesterol ( Very Low Density Liporotein )

22.  Cholesterol
Principle:
 Absorbance of quinoneimine dye is measured at
500nm.
Method:
• Enzymatic method

23. Biological reference range:-
Less than 199 mg /dL (Normal)
200 – 239 mg/dl (borderline)
More than 240 mg/dl (high)
Clinical significance : -
Increase cholesterol suggestive of increase probability of
following
• Atherosclerosis
• Coronary artery disease
• Ischemic heart disease
• Cerebro-Vascular Stroke
• Hypertension
• Xanthoma
Decrease cholesterol suggestive of increase probability of
following
• Depression

24.  Triglyceride
Principle:
 Absorption of quinoneimine dye (red color) is
measured at 510nm.
Method :
 GPO – POD Method
 End point method

25. Biological reference range:-
<150mg/dl
Clinical significance:
• 150 to 400 mg/dl is consider borderline
hypertriglyceridemia.
• More than 400 mg/dl only, increase risk of
pancreatitis

26. HDL , LDL , VLDL

27.  HDL(High Density Lipoprotine)
Principle:
 Precipitates of all lipoprotein other than HDL (LDL
& VLDL lipoproteins)
 Precipitation done by
 Dextran Sulfate
 phosphotungsate acid
 Polyethyl glycol
 HDL left in the supernatant is tested using
cholesterol assay.
Method: Precipitation reaction

28. Biological reference range :- 40-60 mg/dl
HDL less than 40mg/dl means high risk of heart
disease.
Significance:
 HDL transport cholesterol from peripheral tissues
to liver by reverse cholesterol transport.
 HDL also helps in the removal of macrophages
from the arterial walls.

29.  LDL(Low Density Lipoprotien)
Principle:
 Direct method: (selective precipitation)
 Indirect method: (fridewald equation)
LDL = [Total Cholesterol – HDL] – Plasma TG
(mg/dl)
5

30. Biological reference range:- 130-160 mg/dl
LDL more than 160mg/dl means high risk of heart
disease.
Significance:
 LDL tarnsport cholesterol from liver to peripheral
cells.

31.  VLDL(very low density
lipoprotien)
Friedewald’s equation:
VLDL = Triglyceride/5 (mg/dl)
Limitation :
Can not useful in case of TG > 400 mg%
Biological reference range:- 2-30 mg/dl

33. Ratio of Cholesterol

34. DETERMINATION OF
APOLIPOPROTIEN- A1 & B
METHOD:- Turbidimetric immunoassays (TIA)
PRINCIPLE:-
 An insoluble TIA is formed by the reaction
between the apo A-I antigen in human serum &
the specific antibody in the antibody reagent. By
using the activactor reagent,maximum exposure
of antigenic sites achieved.
 The turbidity is measured at 340nm.

35. Biological reference range:-
 Apolipoprotein A:-
 More than 50mg/dl is desirable.
Apolipoprotein B:-
 less than 80mg/dl is desirable.