2. Ischemic necrosis of myocardium due to
sudden occlusion of coronary artery due to
atheromatous plaque.
3. Signs and symptoms
prolong cardiac pain
radiating to chest, arms,
throat and back.
4. Signs and symptoms……
Increased Erythrocyte Sedimentation
Rate.
Chest x rays shows pulmonary
edema.
5. Atherosclerosis
A form of arteriosclerosis where the tunica
intima of large and medium sized arteries is
affected due to formation of fibrofatty plaques
or atheromas.
9. A complex reaction in tissues that consist
mainly of responses of blood vessels and
leucocytes.
-Robbins and Cotrans
A protective response triggered by
inflammatory mediators (interleukins,
tumor necrosis factor).
10.
11. Inflammation …..
One of the main cause of atherosclerosis.
Inflammation as a main cause of myocardial
infarction has been a subject of studies for
years as conformed by various studies .
-Ross 1999, Semeri etal 1992, Thompson etal 1995
12. Some predisposing factors like
Diabetes,Hypertension,Hyperlipidemia
can intensify inflammation of coronary
arteries.
Indicators of inflammation (ICAM-1,
VCAM-1, IL-1, IL-6, TNF, CRP).
C- reactive protein (CRP)- an important
inflammatory marker.
13. Measuring inflammatory indicators other
than screening plasma lipid is a useful
prediction of myocardial infarction.
In case inflammation is cause,CRP may
reveal the etiology and can be guide for
management strategy.
14. An acute phase protein , the level rises
in response to inflammation.
It is a pentraxin , each subunit having
MW -33kDa.
Synthesized by hepatocytes in response
to factors released by fat cells
(adipocytes).
15.
16. Binds to phosphocholine and activate
complement system and also enhance
phagocytosis by macrophages.
Increased level of CRP may be induced
by metabolic, infective, immunologic or
other processes.
17. Normal concentration - >10 mg/L,
slightly increases with aging.
Higher levels are found in late
pregnancy, bacterial infections , viral
infections, mild inflammations and burns.
Increased CRP level indicate tissue
damage and inflammation.
18. CRP levels:
- Decreased by :
Statins, aspirin, α-tocopherol (vitamin E)
and loss of weight
- Increased by :
hormonal therapy will increase CRP levels.
CRP is more sensitive and accurate reflection
of acute phase response than ESR (Erythrocytes
Sedimentation Rate)
19. CRP is a prognostic marker of
cardiovascular events.
Predict myocardial infarction, stroke,
peripheral arterial disease and sudden
cardiac death.
20. CRP is an indirect marker of increased
cytokine response to inflammation.
Person with high CRP level had relative
risk of myocardial infarction 3 to 4 times
higher than those with low level.
22. CRP is stronger predictor of myocardial
infarction than LDL cholesterol.
In clinical practice; even LDL cholesterol
level below 130mg/dl and with c-RP
level >3mg/L represent high risk group.
Because of less specificity of CRP, highly
sensitive CRP(hsCRP) has been used
these days.
23. Advantage of CRP over other
inflammatory indicators like Interleukins,
Tumor Necrosis Factor:
Easy
Effective
Inexpensive to measure.
24. Should not be measured within 3 weeks
of acute inflammation
CRP measured within 12 hours of onset of
symptom is not related to long term
prognosis.
27. 1st laboratory method to measure CRP level.
Agglutination and precipitation indicates the
presence of CRP in the serum sample.
A positive result indicate a CRP level greater
than 10mg/L.
Can be performed within 10 to 20 minutes.
28. Semi quantitative Latex Agglutination
Method
Dilution of serum
Mixed with latex reagent
Agglutination was observed
Highest dilution in which agglutination is observed
corresponds to approximate concentration of
CRP-ligand complex
This method detects CRP level in between 6-10 mg/L.
29. Most rapid, sophisticated and sensitive
method.
2 types:
- ELISA
- Immunoflourescence Quantitative Test
30. Monoclonal Anti-CRP Antibodies conjugated with an
Enzyme
Diluted human serum is added
Formation of CRP-ligand complexes
Removal of unbound Antibodies
Florescent marked CRP-ligand complex is
measured under Radio Immune Assay(RIA)
31.
32. It is a strong predictor of CVS events than
cholesterol.
It adds prognostic information at all level
of metabolic syndrome.
Prediction of risk group of CVS problem:
CRP level< 1mg/L: low risk group
CRP level 1-3mg/L:moderate risk group
CRP level>3mg/L:High risk group
33. Biochemical and pathological components
are responsible for formation of
Atherosclerotic plaque
Manifests as myocardial infarction
hsCRP and CRP are useful diagnostic and
prognostic marker of myocardial infarction.
34. Various methods are still on the way for
the prognostic and diagnostic purpose
of MI.
Latex agglutination method , ELISA and
immunofluorescence test commonly
used for measurement of CRP.
