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.