CARDIAC PROFILE TESTS

CARDIAC PROFILE TESTS

These tests may be useful to find out the possibility of disturbed carbohydrate metabolism due to
diabetes meliltus, as an atherogenic risk factor and also the possible existence of pre-renal condition.
Cardiac Profile Tests

Group 1 tests

1) Blood sugar (F) and (PP)

2) Serum (or plasma) urea nitrogen
3) Serum creatinine
4) Serum electrolytes

These tests may be useful to find out the possibility of disturbed carbohydrate metabolism due to
diabetes meliltus, as an atherogenic risk factor and also the possible existence of pre-renal condition.

Group 2 tests

5) Serum total cholesterol

6) Serum UDL-cholesterol
7) Serum total cholesterol/HDL-cholesterol ratio
8) Serum triglycerides
9) Serum VLDL and LDL

These are cardiac risk evaluation tests.

Group 3 tests

10) CPK (and CPK-MB)

11) SGOT
12) LDH
13) SHBD

These are cardiac injury panel tests.

Cardiac Injury Panel Tests

General consideration

The cardiac injury panel tests are performed together to 1) assess the severity of heart disease 2) follow
the trend of the disease and 3) determine postoperative risk. In at least 10% of the patients the E.C.G.
findings do not necessarily permit a clear diagnosis to be made. Approximately 20% of myocardial
infarcts are silent, occurring particularly in the elderly, diabetics & hypertensive patients.
Determinations of CK (CPK), CK-MB, SGOT, SHBD (HBDH) and LDH plays a major role in the differential
diagnosis & monitoring of myocardial infarction.

Elevated enzymes after acute myocardial infarction

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CPK

An increase in CPK activity is seen following a myocardial infarction in which it is increased earlier than
other enzymes, beginning within 6 hours and peaking on an average at 24 hours and returning to nor
ma! within 2-3 days. The area under the peak and the slope of the initial rise are proportional to the size
of the infarct.

SOOT

The increase begins 3-8 hours after the onset of the attack and returns to normal in 3-6 days. The
highest values are found, on an average, some 24 hours after the onset. The duration and extent of the
increase is related to the size of the infarct.

LDH

An increase in LDH activity is found beginning within 6-12 hours and reaching a maximum at about 48
hours. The increase is roughly similar to SOOT hut it takes a longer time before normal values are
reached again (12-16 days).

SHBD

SHBD activity is a more sensitive index of myocardial infarction. An increase is observed similar to LDH
but remains increased for a longer time (even after 16-18 days).

Note: 1) In patients with infarction the CK-MB isoenzyme usually exceeds 6% of the total activity. The CK
/ GOT ratio is helpful in differentiating between disorders of myocardial infarction & skeletal muscle. In
myocardial infarction patients, the CK/GOT ratio is generally below 10. Ratios above 10 indicate
muscular damage.
2) Silent myocardial infarction: The silent i.e. pain free infarcts occur in diabetic, hypertensive & patients
with impaired peripheral arterial blood flow. Such cases are approximately 20% and enzyme assays in
combination with E.C.G. findings contribute towards differential diagnosis.
3) Angina pectoris is not usually associated with increased CK activity. In tachyrhythmia & congestive
cardiac failure increase in CK may be found.

Group 4 tests

• Serum Myoglobin
• Serum α-i-acid glycoprotein
Myoglobin is the O binding protein of striated (cardiac or skeletal) muscle. Increase in serum myoglobin
concentration occurs after trauma to either skeletal or cardiac muscle, as in crush injury or myocardial
infarction, respectively.

— In myocardial infarction high serum myoglobin concentrations (>90µg/L) are observed within 2- 3
hrs after pain begins, i.e. 3-4 hrs earlier as CK or CK—MB. Negative results (< 85ng/L) excludes
myocardial infarction with a high probability.
— Increased serum levels of α-i-acid glycoprotein core found which have prognostic value. α-i-acid
glycoproteins also increase in coronary thrombosis.

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Normal ranges

Male Female
Serum Myoglobin 12-78 µg/L 3-76 µg/L
Serum α-1-acid glycoprotein 0.5-1.3 g/L 0.4-1.2 g/L

Note: Following tests are useful in acute rheumatic fever

C-reactive Protein
Measurement of serum levels are useful in monitoring disease activity and response to antibiotics.
C and C Proteins
determination of these proteins is useful in monitoring acute rheumatic fever C3 and C4 serum levels
are reduced in the initial phases. C4 levels return to normalcy usually after 10-14 days. C3 levels return
to normal during convalescence. Pro longed low levels of C3 have a poor prognosis.

Normal ranges

C3 (measured as (3C) : 0.5-0.92 g/L

C4 (measured as (4C) : 0.11-0.38 g/L

1gM, IgG and IgA levels in serum

In subacute bacterial endocarditis, 1gM and IgG serum levels are increased whereas IgA is normal or
reduced.
Determination of serum myoglobin, a-i-acid glycoprotein, C3, C4, 1gM, IgG and IgA is performed by rate-
nephelometry by using a nephelometer.

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