Cardiac Biomarkers
Continuing Education Credits
Each year in the US alone, over one million individuals are diagnosed with an acute myocardial infarction (AMI) and approximately one half of these have had an AMI in the past. However, as many as 1 - 5% of patients with an AMI are misdiagnosed in the emergency department and are discharged. Rapid diagnosis of acute myocardial infarction is vital and laboratory testing that is sensitive and specific is essential. Upon completion of this course, you will be able to identify the characteristics of an optimal cardiac biomarker and discuss the laboratory tests that are most useful for rapid diagnosis and monitoring of ischemic heart disease and heart failure.
Objectives
- Describe the role of cardiac biomarkers, the characteristics of a good marker of cardiac disease, and the use of cardiac biomarkers today.
- Explain atherosclerosis as an inflammatory process.
- Compare and contrast the cardiac biomarkers cTnI and cTnT.
- Discuss the utilization of CK-MB, myoglobin, and CK-isoform measurement in diagnosis of an acute myocardial infarction.
- Describe the formation of BNP and NT-proBNP and their role as markers of congestive heart failure.
- Interpret the measurement results of cardiac biomarker assays in the diagnosis of an acute myocardial infarction and congestive heart failure.
- Explain the role of cardiac biomarkers in risk stratification of those with heart disease.
Course Outline
- Cardiac and Vascular Disease
- Introduction
- Organizations and Agencies
- The Human Heart
- Which heart chamber pumps oxygenated blood out to the body?
- Terminology Describing Ischemic Heart Disease and Heart Failure
- Acute Coronary Syndrome
- Risk Factors for Heart Disease
- Match each of the following definitions associated with heart disease and heart failure to the term that it defines.
- True or False: Congestive heart failure (CHF) ordinarily results when the left ventricular myocardium is weakened.
- Atherosclerosis
- Fibrous Cap
- Lipids
- Monitoring Lipids
- A buildup of plaque that occurs with atherosclerosis may eventually lead to which of the following events?
- Biomarkers of Cardiac Disease
- Heart Disease and Cardiac Biomarkers
- Uses of Cardiac Biomarkers
- Optimal Cardiac Biomarkers
- Current Cardiac Biomarkers
- Biomarkers in AMI
- History
- Troponin
- Cardiac Troponin I (cTnI)
- Cardiac Troponin T (cTnT)
- Use of Troponin
- Troponin Measurement and Ranges
- Select the correct statement regarding troponin.
- CK-MB
- Myoglobin
- CK-Isoforms
- Pattern of AMI Biomarker Levels
- High-Sensitivity Troponin
- New Recommendations for hsTn
- Diagnosis of an Acute Myocardial Infarction (AMI)
- Biomarker Sampling
- Which of the following cardiac biomarkers can be used as a stand-alone marker, and is therefore the preferred biomarker to indicate the presence of an AMI?
- A 62-year-old patient has been brought by ambulance to the emergency department. The patient is a smoker with a history of uncontrolled hypertension. While doing some outside painting at home, they became light-headed and complained of sharp pains in their chest. An ECG and cardiac troponin I (cTnI) serial testing are ordered.There is an abnormal ST elevation seen with ECG.ParameterResultBaseline
- While driving home after work, a 45-year-old construction worker is involved in a collision with another car. Upon arrival in the emergency department, the patient complains of chest pain along with severe pain from accident injuries. X-rays and laboratory assays including cardiac biomarkers are ordered.BiomarkerReference ValuePatient Result at PresentationPatient Result at 6 HoursPatient Result a
- Biomarkers in CHF
- Cardiac Biomarkers and Congestive Heart Failure (CHF)
- Function of BNP
- BNP versus NT-proBNP
- BNP versus NT-proBNP, continued
- BNP and NT-proBNP Measurement and Ranges
- What is the function of the BNP hormone?
- A 79-year-old diabetic lives alone since the death of their partner 5 years ago. At age 75, they were diagnosed with an AMI and had another AMI last year. In the past 6 weeks, they have been weak and often lack energy. For the past 2 days, the symptoms have worsened with shortness of breath with any exertion. They are brought in to see the cardiologist who orders a BNP to evaluate their cardiac di
- Risk Stratification and Cardiac Biomarkers
- Risk Stratification
- Biomarkers to Identify Those at Risk for Developing Cardiac Disease
- Other Cardiac Risk Markers
- High-Sensitivity C-Reactive Protein (hs-CRP)
- Use of hs-CRP
- CRP and hs-CRP Comparison of Concentrations
- References
- References
Additional Information
Level of Instruction: Intermediate
Intended Audience: Medical laboratory scientists and technicians as well as other health care personnel who have an interest in this subject matter. This course is also appropriate for medical laboratory science students and pathology residents.
Author Information: Mary Ellen Koenn, MS, MLS(ASCP) is an associate professor emeritus at West Virginia University School of Medicine, Medical Laboratory Science Program. During her career as a medical technologist and educator, she has been a laboratory supervisor and manager and has held several teaching positions. She is the author of numerous articles for laboratory publications and textbook chapters and is a frequent presenter at laboratory seminars and workshops. Mary Ellen Koenn holds a Master of Science degree in Medical Technology.
Reviewer Information: Laurie Bjerklie, MA, MLS(ASCP)CM is
currently an Education Developer for MediaLab and LabCE. She earned a B.S. in
Medical Laboratory Science from the University of North Dakota and an M.A. in
Curriculum and Instruction from Saint Xavier University. She has over 15 years
of experience in higher education and has held program director and faculty
positions in both MLT and MLS programs