 Welcome to nursing school explain and this video on cardiac enzymes or cardiac markers like they also Sometimes called now cardiac enzymes are a very very important lap test that we use That helps us in the diagnosis of myocardial infarction or a heart attack and as a quick review here and I also have a video that goes more into the description of The myocardial infarction into the pathophysiology signs and symptoms on so forth if you're interested But in an MI there is lack of blood flow or no blood flow to one or more of the coronary arteries That results first in ischemia. So lack of blood flow eventually there will be injury and if there is no intervention then the patient will have a full infarction and Cardiac enzymes are proteins released into the bloodstream from the heart muscle itself and These proteins are basically a cry for help from the heart muscle when it's under duress When it just does not get enough blood flow to perform the function that it usually would perform and So it's indicative of injury to muscle cells. So whenever these cardiac enzymes are elevated We have to pay attention and we really have to treat the patient quickly Now the most common or the most important cardiac marker is troponin and the reason why is because it's cardiac specific Recall that we have several different muscle tissues in our body Skeletal and cardiac muscle being two of them and these different cardiac markers are sometimes not as specific But troponin is the one that is Only specific to the heart muscle so cardiac muscle So therefore when troponin is elevated any elevation means that there is something going on with the heart That it's a cry for help that this heart is either have an injury or an infarction And then we have to distinguish between CK, which is creatine kinase and there are three different Cardiac markers here depending on what tissue gives off these enzymes and CKMM would be more indicative for skeletal muscle CKBB for brain and nervous tissue and then CKMB is here more specific for the heart so many times we look at troponin and the CKMB in conjunction and then the third enzyme that we look at is myoglobin and Myoglobin actually gets released when there is something going on with heart or skeletal muscle But it's an early indicator of injury or infarction So myoglobin will be one of those enzymes that gets elevated the first So if the patient comes in right away after they start having some symptoms and only the myoglobin is indicated It does not mean that there's nothing going on with the heart muscle But it's an early indicator so many times we will keep the patient of course we'll check in EKG See if there is a stem or a non stemming going on and then determine How soon after this first set of cardiac enzymes we might need to measure or draw another set Myoglobin here again is non-specific so it could be hard to escalate the muscle But it's an early indicator So if it's elevated most likely we'll have to draw some repeat enzymes to see how the trends are going And over here we have a graph and then a table as to the onset peak and duration For different cardiac markers. So the most important one troponin here in red again Gets elevated after four to six hours of injury to that cardiac muscle The peak is at 10 to 24 hours, but it lasts 10 to 14 days So that's can be elevated quite some time So if we look at the graph here, so it starts kind of more At a steep incline and then kind of drops off at a more flat curve And you can see here that these are hours and over here are days So this really could be up to two weeks elevated So what what is important to note here because it has such a long duration if your patient has been hospitalized or has Had an MI in the last 14 days Their cardiac markers will remain elevated, but remember that we have to always trend the lab value So then we have to see what what was it previously? Is it no more elevated than it was before or is it actually? slowly coming down like it would be here shown in this graph and then CKMB is The the blue line here. So the onset of elevation is three to six hours It peaks at 10 to 24 and lasts I'm sorry 12 to 24 and then lasts about 12 to 48 hours And this won't be as elevated and again Here's the graph that corresponds with that and then myoglobin here Remember I said that it's an early indicator of injury or infarction So if the patient comes in shortly after they start having symptoms only the myoglobin will be elevated if they come in Let's say a two hours after the symptoms started. We won't see any of the CKMB or the troponin elevated But the myoglobin might be elevated because it starts as soon as two hours after the injury occurs And so it peaks at three to 15 hours and it's very short-lived for about 24 hours And so that's when the patient comes in and they come here at hour two and we only see myoglobin elevated then we'll have to wait and Draw the enzymes at a later So maybe four hours later or three hours later Which will then be at our five or six and then we might see an increase in these other two the troponin and the CKMB already and Then determine what needs to happen for a course of action here So thank you for watching this video on cardiac enzymes. I have a lot of other videos that pertain to myocardial infarction because the topic of myocardial infarction is so important because one of the major global causes of mortality and Mobility is cardiovascular disease which in turn or when it gets really bad can lead to myocardial infarction So please give me a thumbs up if you enjoyed the video and I'll see you soon right here on nursing school explain Thanks for watching