Acute Coronary Syndrome 2014

7/24/2019 Acute Coronary Syndrome 2014

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LABORATORY DIAGNOSISOF ACUTE CORONARY

SYNDROME

Dennis Macapagal, MD


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Objecties

B! t"e en# $% t"is sessi$n !$& 'ill be able t$()*Disc&ss t"e bi$c"e+ical +a-es t"at ae &se#

t$ #etect ac&te +!$ca#ial in%acti$n*

.*Disc&ss t"e sensitiit! an# speci%icit! $% C/0MBan# t"e T$p$nins %$ t"e #etecti$n $% AMI

1*Disc&ss $t"e tests t"at ae in#iectl! "elp%&l in

#iagn$sing an ac&te c$$na! s!n#$+e*


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Oeie'2

1 "$&s $% isc"e+ia3456 is- $% cell#eat"

7 "$&s3)556 cell #eat"

F$ t"is eas$n, eal! ec$gniti$n $%

pesistent isc"e+ia an# inteenti$n

t$ est$e bl$$# %l$' ae nee#e# t$

+ini+i8e cell #eat"*


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Oeie'2

9eat #isease is an a%%licti$n

inti+atel! tie# t$ "ig" tec"n$l$g!*

Tec"n$l$g! "as "a# a ca&sal $le,

in pat b! all$'ing pe$ple t$ lie

l$nge, an# in pat b! enabling ase#enta! an# $el! c$ns&+ptie

li%est!le*


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Oeie'2

D&ing t"e .5T"cent&!, "eat

#isease $se %$+ $bsc&it! t$

bec$+e t"e lea#ing ca&se $%

+$bi#it! an# +$talit! in #eel$pe#nati$ns*


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Oeie'2

Diagn$sis an# teat+ent $% "eat

#isease als$ #epen# "eail! $na#ance# tec"n$l$g!, incling

elect$p"!si$l$gic, i+aging,

cat"etei8ati$n, s&gical an# clinical

lab$at$! testings*


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Oeie'2

9eat #isease statistics in t"e US2)* est 45M :ab$&t ) in 1; "as s$+e

%$+ $% CM "ae a "ist$! $% C9D

1* 4M "ae "a# an MI

?* )5M "ae "a# an angina pect$is

@* 7M "ae 9F

7* >M "ae epeience# st$-e


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Oeie'2

9eat #isease statistics in t"e US2

>* C


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Oeie'2

9eat #isease statistics in t"e US2

4* T"ee is an ala+ing incease in

$besit! an# t!pe . DM '"ic" 'ill

%&el t"e epi#e+ic %$ +an! !east$ c$+e*


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N$n0lab$at$! is- %act$s %$ C9D2

)* S+$-ing :an! s+$-ing in t"epast +$nt";

.* 9=N :)?55++9g;

1* Age :+en $e ?@ !easF@@;

?* Obesit!

@* DM7* Se#enta! li%est!le


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/e! p$ints2

)* Meas&e+ent $% p$teins pesent in

ca#iac +!$c!tes in#icates ecent#a+age t$ ca#iac +&scle*

.* Meas&e+ent $% s&bstances t"at ae

#a+aging t$ t"e c$$na! ateies, $ at

least "ae been p$en ass$ciati$n

'it" c$$na! "eat #isease, is &se# t$assess is- an# select app$piate

peentie +eas&es* T"e +$st

i+p$tant lab is- %act$s ae LI=IDS*


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Serial sampling for cardiac markers

ti+e 'in#$' %$+ #eat" $% +&scle t$elease +a-es in bl$$#

ESC H ACC

)* $n a#+issi$n

.* 70 "$&s

1* ).0.? "$&s :i% ealie speci+ens'ee negatie; an# t"e clinical

s&spici$n %$ MI is "ig"

=OC testing +&st be aailable ALL


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Serial sampling for cardiac markers

9ist$icall!2 LD9 H C/

.5 !eas ag$T$p$nin antib$#iesc&entl!, t"e +a-es assa! incle2

0M!$gl$bin

0T$p$nins0C/ is$en8!+e :MB;


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CARDIAC ENJYME MAR/ERS29ist$ical #eel$p+ent2

)@5Ks0La D&e et al inestigating

tansa+inases :AST;


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9ist$ical #eel$p+ent2

Tansa+inases "ae n$t en#&e#

as ca#iac +a-es beca&se t"e!

ae n$t speci%ic t$ t"e "eat* An#

s$$n a%teLD9 an# C/*


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CREATINE =9OS=9O/INASE


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N t t


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Ne'e tests2

T$p$nins("ig"l! speci%ic

A c$+ple $% t"ee p$teins t"at

esi#es at eg&la inteals in t"et"in %ila+ent $% stiate# +&scle*

TnT, TnI, TnC

TnC3i#entical %$+s in T!pe . an#

ca#iac +&scle

TnI H TnT3ca#i$speci%ic


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T$p$nins

In c$ntast 'it" $t"e +a-es, t"ei

leels ae al+$st &n#etectable $

8e$ in n$+al se&+* :#etecti$nli+its $% 5*5)ng+l;

T"e t"pecentile $% t"e "ealt"!p$p&lati$n is a$&n# 5*5?ng+l

#epen#ing $n t"e assa!*


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T$p$nins

Leels ab$e t"is t"es"$l# ae

al+$st cetainl! in#icatie $%

+!$c!te #a+age b&t p$ssibl!eeal a +&c" lesse a+$&nt $%

#a+age t"an 'as #etectable 'it"ealie ca#iac +a-es s&c" as C/0

MB*


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T$p$nins

N$te t"at eleati$n +a!be %$&n# in

peica#itis, +!$ca#itis, =E, enal

%ail&e, sepsis, an# $t"e citicalillness*

=$l$nge# intense eecise, s&c"as +aat"$n can ca&se s+all

eleati$ns*


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T$p$nins

NB2(in "ealt"! ne'b$ns, leels as

"ig" as 1*5ng+l "ae been %$&n#


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Ot"e +a-es %$ c$$na! is-2


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C0REACTI


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Fist is$late# in )15 in patients 'it"

pne&+$c$ccal pne&+$nia

s$ na+e# beca&se it bin#s t$ t"e C0

p$l!sacc"ai#e $% t"e pne&+$c$cc&s

Late it 'as %$&n# t"at it appeae# in

plas+a #&ing in%ecti$&s $in%la++at$! c$n#iti$ns*

It is t"e $iginal ac&te p"ase


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It is t"e $iginal ac&te p"ase

eactant p$tein*

N$+al leel3)+g+l

in ac&te illness, leels +a! eac" as

"ig" as 155+g+l

Baseline aeage 'as )*@+g+l %$

t"$se '"$ #eel$pe# MI* It is p$ in%la++at$!


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It is p$ in%la++at$!*

Still, CR= "as an &nclea $le in t"epat"$genesis $% asc&la #isease*

B&t t"e A9A s&ggeste#2

as!+pt$+atic +en @5 !eas an#

'$+en 75 !eas be sceene#

een i% LDL c"$leste$l is n$t

eleate#*


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9OMOCYSTEINE


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9c! is a s&l%& c$ntaining a+in$

aci# an# a +etab$lic inte+e#iate*

9$+$c!stin&ia2

0"$+$8!g$&s #e%ect in t"e en8!+ec!stat"i$nine0Beta0s!nt"ase

0lens #isl$cati$n, $ste$p$$sis, MR,p!sc"iatic #ist&bance,

t"$+b$e+b$lic #isease :e*g C9D;


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9ig" leels $% 9c!2)* en#$t"elial inj&!

.* platelet actiati$n

t$ na+e a %e' #a+aging e%%ects(

as a C9D +a-e, it paallels t"at $%a "ig" c"$leste$l leel


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F$late s&pple+ents can bing #$'n

eleate# leels $% 9c!*

S&++a!2


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S&++a!2

)* T"e +$st i+p$tant #isease

a%%ecting "eat is c$$na! "eat#isease, '"ic" is at"e$scle$sis

a%%ecting t"e c$$na! ateies*C9D can lea# t$ t"$+b$tic

$ccl&si$n $% c$$na! bl$$# %l$',

ca&sing an ac&te c$$na!

s!n#$+e $ ACS* ACS 'it" %an-

nec$sis $% an! a+$&nt is MI


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.* T"e pi+a! tests %$ #iagn$singACS ae ECG, lab +eas&e+ents

$% ca#iac +a-es '"ic" aep$teins elease# in cic&lati$n %$+

#a+age# "eat +&scle* T"e +$st

i+p$tant ca#iac +a-e t$#a! is

ca#iac t$p$nin :cTn;*


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1* T$p$nin is a c$+ple $% t"ee

p$teins, t'$ $% '"ic" ae s&itableas speci%ic ca#iac +a-e tests2

cTnI an# ctnT


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?* T"ee is a #ela! $% a %e' "$&s

%$ll$'ing MI be%$e cTn is #etecte#in t"e cic&lati$n* It pea-s ab$&t .?

"$&s an# t"en #eclines $e

seeal #a!s


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@* e can als$ +eas&e is- %act$s

ass$ciate# 'it" t"e #eel$p+entan# p$gessi$n $% C9D2 Lipi#s,

"$+$c!steine, CR=


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Assign+ent2Rea# $n(

)* Bain nati&etic pepti#e:BN=;

.* D0#i+e

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Acute Coronary Syndrome 2014