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Physiology

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Basic Concepts

Question
59 out of 95
 

In which of the following conditions the level of creatinine kinase — I increases?



A Myocardial ischemia
B Brain ischemia

C Kidney damage
D Electrical cardioversion

Ans. B Brain ischemia
  1. Creatinine Kinase (CPK) - iso-enzymes

i. Three types

ii. Each iso-enzymes is a dimer, composed of two protomers 'M' (muscles) and 'B' (Brain)

iii. CPK (CK) isoenzymes can be separated by

a. Electrophoresis

b. Ion exchange chromatography

Types

Electrophoretic mobility

Distribution in tissues

CPK-1, BB

Fast moving (more –ve)

Brain

CPK-2, MB

-----

Myocardium

CPK-3, MM

Slow moving

Skeletal muscles

  1. Acute coronary syndrome (ACS) : group - into

i. Acute MI with ST-segment Elevation (=STEMI) and

ii. Unstable angina (UA) and non-ST segment elevation MI (UA/NSTEMI)

  1. CK-MB (CPK-2) and troponin - a much more specific marker of mycocardial necrosis (MI)
  2. The Diagnosis of NSTEMI is established if a patient with the CIF of UA develops evidence of myocardial necrosis as reflected in elevated cardiac biomarkers. Elevated levels of these markers distinguish patient with NSTEMI from those with UA.
  3. Unstable angina:

a. Diagnosis of UA is based largely on the clinical presentation

b. UA is defined as angina pectoris or equivalent ischaemic discomfort with at least one of three following features:

i. It occurs at rest (or with minimal exertion) usually lasting> 10 min.

ii. It is severe and of new onset (i.e. within the prior 4 to 6 wk) and/or

iii. It occurs with a crescendo pattern (i.e. distinctly more severe, prolonged or frequent than previously)

  1. Cardia specific troponin (cTnT and cTnI) their measurement is of considerable diagnostic usefulness and they are now the Preferred biochemical markers for MI Q. Their levels may remain elevated for 7-10 days Qafter STEMI.

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