Cardiac Function Test
 Diagnosis of coronary artery diseases, particularly the
myocardial injury caused by ischemia
 Developed to analyze the myocardial function on a more
comprehensive level where the more insight physiological
and pathological information can be extracted
 Provides a more significant meaning and higher efficacy
than what the conventional EKG can provide
 Valuates the function of the myocardium directly, it can
detect any early subtle changes in myocardial function or
injuries caused by the obstruction of small coronary
arteries which cannot be detected by catheterization or
angiography
Heart
 It pumps blood throughout both the pulmonary and
systemic circulation
 Weighs 250-350 g and about the size of human fist
 Located in the mediastenum between the lungs and
enclosed in a double-walled pericardial sac with serious?
Membrane between the walls to provide lubricating fluis
that facilitates heart movements
 The heart is made up of the two atria which receive blood
and two ventricles which are the actual pumps of the
heart. The left ventricle pumps blood into the aorta
sending oxygenated blood to the rest of the body
Layers of the heart
 Myocardium- cardiac muscle that pumps the blood
throughout the body (middle layer of the heart)
 Endocardium- inner later and forms the heart valves that
separate four chambers of the heart
a. Upper chambers- right and left atria
b. Lower chambers – left and right ventricles
 Interventricular septum- separate left and right sides of the
heart
Blood vessels
 Arteries- transport blood away from the heart into the
lungs or body tissues and arterioles (small branches or
arteries)
 Capillaries- very small vessels that allow the exchange of
the fluids ( O2, Co2, electrolyte, glucose)
 Veins- has thinner walls and less smooth muscle than
arteries (superior & inferior vena & coronary sinus)
 Pulmonary veins- supply blood to the left atrium
 Aorta- removes blood from the left ventricle
Two sets of heart valves
 Atrioventricular valves- located between the atria and
ventricles
 Semilunar valves- located between ventricles, aorta &
pulmonary artery
2 Separate Circulations
 Pulmonary circulation- allows the exchange of oxygen
and carbon dioxide in the lungs
 Systemic circulation- provides the exchange of nutrients
and wastes between the blood and the cells throughout the
body
Cardiac Cycle
 Describes the circulation of blood through the heart and
body as the heart muscles alternates
 Diastole- period of relaxation
 Systole- period of contraction
Symptoms of heart disease
Dyspnea Chest pain
Palpitations Syncope
Fatigue Edema
Fatigue
 Feelings of weakness and fatigue can be considered as
symptoms arising out of inadequate blood flow to the
heart muscles mostly during any physical activity
 This is caused when the heart pumps inefficiently as it
does in heart failure
Chest pain
 The inadequate supply of blood cause chest pain, when
stiffness or grasping sensation in the chest (angina) is
experienced due to inadequate supply of blood
 This is caused when the muscles in the heart do not get
enough blood (a condition referred to as ischemia), and
enough oxygen, to be carried to tissues by the blood
Light headedness and fainting
 This is caused when there is inadequate flow of blood, due
to irregularities in the heart rate or rhythm, the heart
cannot pump adequately resulting in light-headedness,
faintness, or fainting (syncope)
Swelling & Numbness
 Swelling is caused due to the accumulation of fluid
(edema) in tissues.
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 It occurs when blood collect in the leg veins, increasing
pressure in the leg veins and forcing fluids out of the veins
into tissues
 This collecting of pooling of blood may be an indication
of heart failure or venous disorder, such as deep vein
thrombosis. Similarly numbness may be caused along
with swelling of the blood supply to the affected area is
inadequate
Changes in skin color
 The changes in the color of the skin occur when there is
inadequate supply of blood, due to anemia, or o the veins
do not drain adequately.
 These changes may make skin appear pale, bluish or
purplish
Palpitation
 Irregular heartbeats is the prime symptom of palpitations
 Symptoms like shortness of breath, chest pain, fatigue, or
fainting which are more likely to result from an abnormal
heart rhythm or a severe disorder then you may be
suffering from palpitation
 The disease can be properly diagnosed by the doctor with
the help of electrocardiography (ECG)
Shortness of breath
 A very common symptom of heart disease is shortness of
breath which is also called dyspnea
 This symptom is regarded as a common symptom of heart
failure
 The disease occurs due to the condition called pulmonary
congestion or pulmonary edema which is due to when
fluid seeps into the air spaces of the lungs
 Shortness of breath occurs mostly in people suffering
from coronary artey disease and usually occurs during
physical activity
Limitation of Physical activity
 Physical activities are very much needed, if you want to
keeps yourself away from the heart diseases
 A very frequent and common symptom of heart disease is
a person’s limitation on physical activity or in performing
any kind of chores
 Can be graded on that basis as mild, moderate and severe
Other symptoms:
 Orthopnea- breathlessness when a patient lies flat, occurs
when blood is redistributed in the supine position which
increases the pressure of abdominal contents against the
diaphragm
 Paroxysmal nocturnal dyspnea-is an accumulation of the
fluid in the lungs at night
 Cyanosis- bluish discoloration of the skin caused by an
increased amount of non-oxygenated hemoglobin in the
blood
Heart Disease
 Congenital heart disease- involves valvular defects that
interfere with the normal flow of blood, septal defects that
allow mixing of oxygenated blood from the pulmonary
circulation with unoxygenated blood from the systemic
circulation shunts
 Influences
 Alcohol abuse
 Maternal rubella infection
 Infection with German measles
 Drug treatment with radiation
Congestive heart failure
 Results from the inability of the heart to pump blood
effectively
 Characterized by symptoms of accumulation of fluid in
the lungs throughout the body & occurs if the heart
muscle itself is weak or heart is stresses beyond the ability
to react
 Left side of the hearts fails and result in accumulation of
fluids in the lungs (pulmonary edema)
 Right side of the heart fails result in accumulation of fluid
in systemic circulation (generalized edema)
Atrial septal defects
 Due to malformation of ducts and abnormality causes left-
right shunting of blood between atria
 Pulmonary hypertension and atrial arrhythmias are
common if the patient is older than age 30
Coronary heart disease
 Caused by lack of nutrient and oxygen supply to the heart
muscle and results in myocardial ischemia (due to
obstruction in one of the arteries)
Cardiomyopathy
 Abnormality of the heart muscle and dilates out of
proportion resulting in an enlarged heart
Arrhythmias
 Malfunction in cardiac conduction
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Atherosclerosis
 Thickening & hardening of the artery walls caused by ANTISTREPTOLYSIN-O TEST
deposits cholesterol lipid-calsium plaque in the lining of  Protein produced by streptococcal bacteria
arteries  In response to infection, the body produces streptolysin
antibody
Hypertensive heart disease  Antibodies for streptolysin, called antistreptolysin-O
 A systolic pressure of greater than 160 mmHg and antibodies
diastolic pressure greater than 95 mmHg  High levels indicate the presence of an infection like
 Most common cardiovascular disease affecting 505 Endocarditis or rheumatic fever
middle age people
 Normal: 120 systolic, 80 diastolic BLOOD FAT PROFILE
 Prehypertension:120-139 systolic, 80-89 diastolic  Cholesterol
 Stage 1 hypertension: 140-159, 90-99 diastolic  HDL (good cholesterol)
 Stage 2 hypertension-: 160 systolic, 100 diastolic  LDL (bad cholesterol)
 Triglycerides
Rheumatoid heart disease
 Due to infection of Group A Sterptococci Cholesterol
 Desirable: Less than 200 mg/dL (5.18 mmol/L)
Acute Coronary Syndrome (ACS)  Borderline high: 200- 239 mg/dL (5.18 to 6.18 mmol/L)
 It encompasses several clinical situations having  High: 240 mg/dL (6.22 mmol/L) or higher
myocardial ischemia in common; stable angina, unstable
angina, acute MI & sudden cardiac death (SCD) HDL Cholesterol
 Low risk: Less than 40 mg/dL 91.0 mmol/L) for men and
Types less than 50 mg/dL (1.3 mmol/L) for women
 Non-invasive Tests  Average risk: 40-50 mg/dL (1.0-1.3 mmol/L) for men and
 Invasive/Interventional Tests between 50-59 md/dL (1.3-1.5 mmol/L) for women
 Less than average risk: 60 mg/dL (1.55 mmolo/L) or
Non-invasive Test higher for both men and women
 Blood tests
 Carotid & Extremity Vascular Testing LDL Cholesterol
 CAT Scans  Optimal: Less than 100 mg/dL (2.59 mmol/L)
 Echocardiography  Near/above optimal: 100-129 mg/dL (2.59-3.34 mmol/L)
 Electrocardiograms (EKG)  Borderline high: 130- 159 mg/dL (3.337-4.12 mmol/L)
 Holter and Event (Loop) Monitoring  High: 160-189 mg/dL (4.15 4.90 mmol/L)
 Exercise Stress Test
 MRIs Triglycerides
 Desirable: Less tahn 150 mg/dL (1.70 mmol/L)
BLOOD TESTS  Borderline high: 150-199 mg/dL (1.702.2 mmol/L)
 Antistreptolysin-O test  High: 200-499 mg/dL (2.3-5.6 mmol/L)
 Arterial blood gases  Very high: Greater than 500 mg/dL (5.6 mmol/L)
 Blood fat profile
 Blood calcium test BNP BLOOD TEST
 BNP blood test  Measures the level of hormone called B-type natriuretic
 C-reactive protein test peptide
 INR/prothrombin time tests  BNP rises in heart failure
 Serum myoglobin test
 Total serum protein
 Waste products test

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C-REACTIVE PROTEIN TEST
 An inflammatory marker
 Provides information about a patient’s risk of having a
heart attack or stroke
 High levels of CRP in the blood mean there is
inflammation somewhere in the body
CARBON DIOXIDE CONTENT
 Used as an investigative and diagnostic tool for patients
with breathing problems
COMPLETE BLOOD COUNT
 Information about the types of blood cells present
 Condition and number (percentage) in relation to other
cells
ELECTROLYTE PANEL
 Measure the amount of potassium, sodium, chloride and
carbon dioxide levels in the blood
ERYTHROCYTES SEDIMENTATION RATE
 Measures the rate at which red blood cells separate from
plasma
 High levels may occur during a heart attack, rheumatic
fever, giant cell arteritis, severe anemia, cancer relapse or
other conditions
 Low levels may be associated with heart failure, sickle
cell anemia or other conditions
CARDIAC ENZYME TESTS
 Creatine kinase-MB
 Lactate dehydrogenase
 Troponin
Creatine kinase-MB
 An elevation in value indicates myocardial damage
 An elevation occurs within 4 to 6 hours and peaks 18 to
24 hours following an acute ischemic attack
 Normal value is 0% to 5% of total; total CK is 26 to 174
units/L
 It catalyze the transfer of a phosphate group between
creatine phosphates and adenosine diphosphate
 Involved in the storage of high energy creatine pO4 in the
muscles
 Composed of pair of monomers, M and B
 CK-MM, CK-BB, CK-MB
 CK-MM- major isoenzymes (94-100%)
 CK-BB- brain type, rare in adult due to high molecular
size
 CK-MB- hybrid type, myocardium is the only tissue that
releases in significant quantities (20%), sensitive indicator
of AMI
 Following AMI, levels rise within 4-8 hours, peak at 12-
24 hours and normalize in 48-72 hours
Lactate dehydrogenase
 Catalyze the interconversion of lactic and pyruvic acids
tetramic which contains 4 subunits (H and M forms)
 Elevations in LDH levels occur 12-24 hours following MI
and peak in 48 to 72 hours. Remains elevated in 10-14
days
 Normally LDH 1 is lower than LDH 2
Troponin
 Composed of 3 proteins- troponin C, cardiac troponin I,
and cardiac troponin T
 Troponin I especially has a high affinity for myocardial
injury
 Rises within 3 hours and persists for up to 7 days
 Normal values are low, with troponin I being lower than
0.6 ng/mL and troponin T normally ranging from 0 to 0.2
ng/mL
 Any rise can indicate myocardial cell damage
1. Creatine Kinase- enzymes that is involved in the transfer
of energy in muscle metabolism
- Has 3 isoenzymes: CK-MM, CK-MB, CK-BB in
electrophoresis. The fastest migrating is BB (CK1), MB
(CK2), then MM (CK3)
- CK-MB – diagnosis of acute myocardial infarction since
its high specificity for cardiac injury
Myoglobin
 An oxygen-bnding protein found in cardiac and skeletal
muscle
 Level rises within 1 hour after cell death, peaks in 4 to 6
hours
 Returns to normal within 24 to 36 hours
2. AST- first marker used for the laboratory diagnosis of
acute myocardial infarction. It lacks specificity
3. Lactate dehydrogenase (LD) - cytoplasmic enzyme found
in almost all cells of the body and not specific also for MI
 This begins to rise at 6 hours- 12 hours from the onset of
shest pain, peaks 1-3 days and normalize within 8 days
 LD1 and LD2 are subfractions that are specific for the
heart
Abnormal CK Types
 Macro-CK – is a CK-Ig complex. On electrophoresis it
migrates between MM and MB. It is found in completely
healthy elderly women
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 Mitochondrial CK – migrates very close to MM, usually
slower than MM. it is seen in patients with advanced often
disseminated, malignancies and is associated in poor
prognosis.
Troponin T (TnT) – an asymmetrical globular protein
 Allows for both early and late diagnosis of acute
myocardial infarction. Rise after few hours onset of pain
and peak by 2 days.
 Clearly differentiate cardiac damage with muscle damage
Troponin I (TnI)
 Basic globular proteins- found only in the myocardium in
adult and sensitive measure of cardiac injury. Not found in
stress related activity but only in MI
 Increased 3-8 hours after onset of pain, peaks 12-24 hours
 Widely available for use in clinical diagnosis
 Highly cardiospecific than TnT
 Not elevated in skeletal muscle injury and vigorous
exercise
Troponin C
 Dumbbell-shaped proteins but not heart specific
 Cardiac Myosin Light Chains (MLC)
 Specific myocardial proteins and consider specific for
cardiac injury than CK-MB or LD determinations
Cardiac Myosin Light Chains (MLC)
 Specific myocardial proteins and consider specific for
cardiac injury than CK-MB or LD determinations
Cardiac myosin heavy chains (MHC)
 Proteins that are structurally bound to muscle fibers and
will not appear in the circulation except if there is muscle
necrosis
 Significant in late diagnosis of an acute MI or assess the
size of infarction
Ischemia- modified albumin (IMA)
 Altered form of albumin has reduced cobalt-binding
capacity
 Ischemia- modified albumin rises within minutes of
myocardial ischemia and returns to baseline within 6
hours due to rapid hepatic clearance
 Promising marker for transient ischemia
Unbound free fatty acid (u- FFA)
 Is elevated in reversible and irreversible cardiac ischemia
usually very early
Glycogen Phophorylase isoenzymes (B) G PBB
 It is a glycolytic enzymes that play an essential role in the
regulation of CHO metablosim by mobilizing glycogen
 Found in the hearts and brain but seen in wbc platelets,
spleen
 Increased after 3-4 hours after onset of pain
Heart fatty Acid binding Proteins (H-FABP)
 Involved in cellular uptake, transport and metabolism of
fatty acids
 Found in heart and muscle tissues
 Increased after 2 hours and peak 5-10 hours after onset of
pain? (Sorry it’s blurry, I’m not sure if this is correct)
Carbonic anhydrase (CA) Isoenzymes III
 Soluble proteins that catalyzes the hydration of Co2 to
bicarbonate and is involved inpH regulation & transport of
ions
TOTAL SERUM PROTEIN
 Blood contains large amounts of protein
 Measurement gives information about a patient’s
nutritional state and kidney and liver function
 Abnormal protein levels may indicate congestive heart
failure, hypertension, or kidney or liver disease
WASTE PRODUCT TEST
 Measure the levels of specific waste products in the blood
 Includes blood urea nitrogen, creatinine and uric acid
 Abnormal results could be a sign of heart failure, heart
attack or kidney disease
Predisposing Factors
 40 years and above
 Men are prone due to abscence of estrogen
 Family history and lifestyles
 Hyperlipidemia (decreased LDL)
 Smoking
 Hypertension
 Sedentary lifestyles
 Diabetes mellitus
 Response to stress (compulsive behaviour)
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