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BIOMEDIC II
CARDIOVASCULAR SYSTEM
Department of Biochemistry.
Faculty of Medicine, UNHAS
Rosdiana Natzir.
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Objectives
Cardiovascular system (Heart)
Anatomical and physiology
orientation,etc. Biochemical Cardiac markers****
Thrombus formation
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Course Guideline
Outline of labs
Texts required
Attendance
Grading policy
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Learning objectives:
To understand the role of cardiumbiomarkers.
To know the role of enzymatic and nonenzymatic cardium biomarkers.
To understand when the cardium biomarkerswere increasing in the blood level.
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Functions of the Heart
Generating bloodpressure Routing blood: separates pulmonary and
systemic circulations
Ensuring one-way bloodflow: valves Regulating bloodsupply
Changes in contraction rate and force matchblood delivery to changing metabolic needs
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Example case examination lab:
Hb
WBC
Sodium
Potassium
Chloride
Urea
Creatinine
CreatineKinase
Troponin I
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Blood Flow Through the Heart
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The Cardiovascular System(cont.)
Blood :
Complex mixture of cells,water, and various proteinsand sugars.
Fifty-five percent is plasma(liquid).
Forty-five percent is solid.
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The Cardiovascular System
(cont.) Blood (cont.)
Hematocrit measurement of percentage of redblood cells.
Leukocytes 5 types of white blood cells protectagainst disease.
Basophils.
Eosinophils.
Neutrophils.
Lymphocytes.
Monocytes.
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Contractility
and
Norepinephrine
Sympatheticstimulationreleasesnorepinephrineand initiates acyclic AMP
second-messengersystem
Figure 18.22
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Chemical Regulation of the
Heart
The hormones epinephrine and thyroxine increase
heart rate
Intra- and extracellular ion concentrations must bemaintained for normal heart function
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Myocardium - morphology
> Intercalated disks= the fibers are connected to each
other in Z lines
Provide strong union between fibers
> Actin, myosin, tropomyosin, troponin
> Large amount of mitochondrias in tight contact with
fibrils
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Myocardium metabolism
Abundant blood supply, numerous mitochondria,high content of myoglobin(a muscle pigment) as astorage of O2
Metabolism mostly aerobic, only about 1% anaerobic
(during hypoxia possible up to 10% anaerobic, if more
--> not enough energy for contractions)
Utilization of substrates depending on the nutrition
60% fats (mostly FA), 35% carbohydrates, 5%
ketones and AAs
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* The Sarcoplasma of muscle cells contains :
ATP; phosphocreatine & glycolytic enzymes.
* the mass of a muscle is made of 75% water and > 20%protein ( actin and myosin ).
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Carnitine-palmytoyl transferase -1; malonyl-CoA decarboxylase: acetyl CoA
carboxylase-2; AMP-activated protein kinase.
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CARDIAC MARKER
CARDIAC ENZYMES
OTHER CARDIAC MARKERS
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OTHER CARDIAC MARKERS
B NATRIURETIC PEPTIDE (BNP)
N-TERMINAL PRO BNP
PRE-PRO BNP BNP + NT PRO-BNP
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Medical tests that are often referred to ascardiac markers include:
cardiac troponin(the most sensitive and specific testfor myocardialdamage)
creatine kinase(CK, phosphocreatine kinase orcreatine phosphokinase)
Aspartate transaminase(AST, Glutamic OxaloaceticTransaminase(GOT/SGOT) or aspartateaminotransferase (ASAT))
lactate dehydrogenase(LDH) Myoglobin(Mb) has low specificity for myocardial
infarctionand is used less than the other markers.
http://en.wikipedia.org/wiki/Troponinhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Creatine_kinasehttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Liver_function_testhttp://en.wikipedia.org/wiki/Liver_function_testhttp://en.wikipedia.org/wiki/Lactate_dehydrogenasehttp://en.wikipedia.org/wiki/Myoglobinhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Myoglobinhttp://en.wikipedia.org/wiki/Lactate_dehydrogenasehttp://en.wikipedia.org/wiki/Liver_function_testhttp://en.wikipedia.org/wiki/Liver_function_testhttp://en.wikipedia.org/wiki/Aspartate_transaminasehttp://en.wikipedia.org/wiki/Creatine_kinasehttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Troponin -
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Depending on the marker, it can takebetween 2 to 24 hours for the level to
increase in the blood.
Cardiac markers are therefore not
useful in diagnosing a myocardialinfarctionin the acute phase.
The clinical presentation and resultsfrom an ECGare more appropriate inthe acute situation.
http://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/ECGhttp://en.wikipedia.org/wiki/ECGhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Myocardial_infarction -
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Functional characteristics
Role of troponins :
Both cardiac and skeletal muscles are controlled bychanges in the intracellular calciumconcentration
When calcium rises, the muscles contract, andwhen calcium falls the muscles relax.
Troponin is a component of thin filaments (along withactinand tropomyosin), and is the protein to whichcalcium binds to accomplish this regulation.
http://en.wikipedia.org/wiki/Calcium_in_biologyhttp://en.wikipedia.org/wiki/Actinhttp://en.wikipedia.org/wiki/Tropomyosinhttp://en.wikipedia.org/wiki/Tropomyosinhttp://en.wikipedia.org/wiki/Actinhttp://en.wikipedia.org/wiki/Calcium_in_biology -
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Troponin has three subunits, TnC, TnI, and TnT.
When calcium is bound to specific sites on TnC,tropomyosinrolls out of the way of the actin filamentactive sites,
In the absence of calcium, tropomyosin interfereswith this action of myosin, and therefore musclesremain relaxed.
http://en.wikipedia.org/wiki/Tropomyosinhttp://en.wikipedia.org/wiki/Tropomyosin -
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Diagnostic use :
Certain subtypes of troponin(cardiac troponin Iand T) are very sensitive and specific indicatorsof damage to the heartmuscle (myocardium).
They are measured in thebloodto differentiatebetween unstable anginaand myocardialinfarction(heart attack) in patients with chestpain.
http://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Cardiac_markershttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Angina_pectorishttp://en.wikipedia.org/wiki/Blood_testhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Angina_pectorishttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Angina_pectorishttp://en.wikipedia.org/wiki/Blood_testhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Cardiac_markers -
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http://upload.wikimedia.org/wikipedia/commons/2/21/Troponino.jpg -
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Creatine kinase
Creatine kinase (CK), also known as phosphocreatinekinase or creatine phosphokinase (CPK) is an enzymeexpressed by various tissue types.
It catalyses the conversion of creatinetophosphocreatine, consuming adenosine triphosphate(ATP) and generating adenosine diphosphate(ADP).
In tissues that consume ATP rapidly, especiallyskeletal muscle, brainand smooth muscle,
phosphocreatine serves as an energy reservoir for therapid regeneration of ATP.
Thus Creatine Kinase is an important enzyme in suchtissues.
http://en.wikipedia.org/wiki/Enzymehttp://en.wikipedia.org/wiki/Creatinehttp://en.wikipedia.org/wiki/Phosphocreatinehttp://en.wikipedia.org/wiki/Adenosine_triphosphatehttp://en.wikipedia.org/wiki/Adenosine_diphosphatehttp://en.wikipedia.org/wiki/Skeletal_musclehttp://en.wikipedia.org/wiki/Brainhttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Brainhttp://en.wikipedia.org/wiki/Skeletal_musclehttp://en.wikipedia.org/wiki/Adenosine_diphosphatehttp://en.wikipedia.org/wiki/Adenosine_triphosphatehttp://en.wikipedia.org/wiki/Phosphocreatinehttp://en.wikipedia.org/wiki/Creatinehttp://en.wikipedia.org/wiki/Enzyme -
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Clinically, creatine kinase is assayed in blood tests as a
marker of myocardial infarction(heart attack),rhabdomyolysis(severe muscle breakdown), musculardystrophyand in acute renal failure.
Types :
In most of the cell,the CK enzyme consists of two
subunits, which can be either :B(brain type) or
M(muscle type).
There are, therefore, three differentisoenzymes:CK-MM,
CK-BB
CK-MB.
http://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Rhabdomyolysishttp://en.wikipedia.org/wiki/Muscular_dystrophyhttp://en.wikipedia.org/wiki/Muscular_dystrophyhttp://en.wikipedia.org/wiki/Acute_renal_failurehttp://en.wikipedia.org/wiki/Cell_%28biology%29http://en.wikipedia.org/wiki/Isoenzymehttp://en.wikipedia.org/wiki/Isoenzymehttp://en.wikipedia.org/wiki/Cell_%28biology%29http://en.wikipedia.org/wiki/Acute_renal_failurehttp://en.wikipedia.org/wiki/Muscular_dystrophyhttp://en.wikipedia.org/wiki/Muscular_dystrophyhttp://en.wikipedia.org/wiki/Rhabdomyolysishttp://en.wikipedia.org/wiki/Myocardial_infarction -
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The genes for these subunits are located on
different chromosomes: Bon 14q32 and Mon
19q13.
The myocardium(heart muscle), in contrast,
expresses CK-MM at 70% and CK-MB at 25-30%.
CK-BB is expressed in all tissues at low levels andhas little clinical relevance.
The mitochondrial creatine kinase (CKm), whichproduces ATP from ADP by converting creatine
phosphate to creatine, is present in the
mitochondrial intermembrane space.
http://en.wikipedia.org/wiki/Chromosomehttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Chromosome -
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Apart from the mitochondrial form, there
are three forms present in the cytosol
CKa : (in times of acuteneed, produces ATP in the
cytosol at the cost of creatine phosphate),
CKc :(maintains critical concentration of creatine
and creatine phosphate in the cytosolby coupling
their phosphorylation and dephosphorylation
respectively with ATP and ADP) and
CKg : (which couples direct phosphorylation of
creatine to the glycolyticpathway.
http://en.wikipedia.org/wiki/Image:Creatine_kinase.PNG -
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creatine
Creatin kinase, muscle
http://en.wikipedia.org/wiki/Image:Creatine_kinase.PNGhttp://en.wikipedia.org/wiki/Image:Creatine2.png -
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http://en.wikipedia.org/wiki/Image:1AAM.png -
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Aspartate aminotransferase.
Aspartate aminotransferase from Escherichia coli
bound with cofactor pyridoxal 5-phosphate(PDB1AAM)
http://en.wikipedia.org/wiki/E._colihttp://en.wikipedia.org/wiki/Pyridoxal-phosphatehttp://en.wikipedia.org/wiki/Protein_Data_Bankhttp://www.rcsb.org/pdb/explore/explore.do?structureId=1AAMhttp://www.rcsb.org/pdb/explore/explore.do?structureId=1AAMhttp://en.wikipedia.org/wiki/Protein_Data_Bankhttp://en.wikipedia.org/wiki/Pyridoxal-phosphatehttp://en.wikipedia.org/wiki/Pyridoxal-phosphatehttp://en.wikipedia.org/wiki/Pyridoxal-phosphatehttp://en.wikipedia.org/wiki/E._colihttp://en.wikipedia.org/wiki/Image:1AAM.png -
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Lactate dehydrogenase
Lactate dehydrogenase(LDH) is an enzymepresent in a wide variety of organisms, including
plants and animals.
Reactions:
It catalyses the interconversion of pyruvateand
lactatewith concomitant interconversion ofNADH and NAD+.
.
http://en.wikipedia.org/wiki/Enzymehttp://en.wikipedia.org/wiki/Pyruvatehttp://en.wikipedia.org/wiki/Lactic_acidhttp://en.wikipedia.org/wiki/Nicotinamide_adenine_dinucleotidehttp://en.wikipedia.org/wiki/Nicotinamide_adenine_dinucleotidehttp://en.wikipedia.org/wiki/Lactic_acidhttp://en.wikipedia.org/wiki/Pyruvatehttp://en.wikipedia.org/wiki/Enzyme -
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Catalytic function of LDH
Enzyme isoforms :LDH-1 (4H) - in the heart
LDH-2 (3H1M) - in the reticuloendothelial system
LDH-3 (2H2M) - in the lungs
LDH-4 (1H3M) - in the kidneys
LDH-5 (4M) - in the liverand striated muscle
At high concentrations of lactate, the enzyme exhibits
feedback inhibition and the rate of conversion of pyruvate
to lactate is decreased
http://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Reticuloendothelial_systemhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Striated_musclehttp://en.wikipedia.org/wiki/Striated_musclehttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Reticuloendothelial_systemhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Image:LDH_reaction.png -
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The major isozymes of skeletal muscle and liver, M4,has four muscle (M) subunits;
while H (heart)4 is the main isozymes for heart muscle in
most species, containing 4 H subunits.
The other variants contain both types of subunits.
Usually LDH-2 is the predominant form in the serum.
http://en.wikipedia.org/wiki/Serumhttp://en.wikipedia.org/wiki/Serum -
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Myoglobin
Myoglobinis a single-chainglobularproteinof 153 amino acids,
containinga heme(iron-containingporphyrin) prosthetic groupin the centeraround which the remaining apoproteinfolds.
It has amolecular weight of 16,700daltons, and is the primary oxygen-carrying pigmentof muscletissues.
http://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Amino_acidhttp://en.wikipedia.org/wiki/Amino_acidhttp://en.wikipedia.org/wiki/Tertiary_structurehttp://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Amino_acidhttp://en.wikipedia.org/wiki/Porphyrinhttp://en.wikipedia.org/wiki/Prosthetic_grouphttp://en.wikipedia.org/wiki/Prosthetic_grouphttp://en.wikipedia.org/wiki/Prosthetic_grouphttp://en.wikipedia.org/wiki/Prosthetic_grouphttp://en.wikipedia.org/wiki/Prosthetic_grouphttp://en.wikipedia.org/wiki/Porphyrinhttp://en.wikipedia.org/wiki/Prosthetic_grouphttp://en.wikipedia.org/wiki/Apoproteinhttp://en.wikipedia.org/wiki/Apoproteinhttp://en.wikipedia.org/wiki/Atomic_mass_unithttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Atomic_mass_unithttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Pigmenthttp://en.wikipedia.org/wiki/Musclehttp://en.wikipedia.org/wiki/Musclehttp://en.wikipedia.org/wiki/Pigmenthttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Atomic_mass_unithttp://en.wikipedia.org/wiki/Apoproteinhttp://en.wikipedia.org/wiki/Prosthetic_grouphttp://en.wikipedia.org/wiki/Porphyrinhttp://en.wikipedia.org/wiki/Ironhttp://en.wikipedia.org/wiki/Hemehttp://en.wikipedia.org/wiki/Amino_acidhttp://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Tertiary_structurehttp://en.wikipedia.org/wiki/Tertiary_structurehttp://en.wikipedia.org/wiki/Tertiary_structure -
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Model of helical
domains in myoglobin Molecular Function:
oxygen transporter activity
iron ion binding
oxygen binding
heme binding
metal ion binding
Biological Process:
response to hypoxia transport
oxygen transport
enucleate erythrocyte differentiation
http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0005344http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0005506http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0019825http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0020037http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0046872http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0001666http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0006810http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0015671http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0043353http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0043353http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0015671http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0006810http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0001666http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0046872http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0020037http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0019825http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0005506http://amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=details&search_constraint=terms&depth=0&query=GO:0005344http://upload.wikimedia.org/wikipedia/commons/6/60/Myoglobin.png -
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Role in disease
Myoglobin is a sensitive marker for muscle injury, makingit a potential marker for heart attackin patients withchest pain.
CK-MB and TnT is used in combination with ECG, and
the clinical signs to diagnose AMI
The released myoglobin is filtered by the kidneysbut istoxic to the renal tubular epithelium and so may causeacute renal failure.
http://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Kidneyshttp://en.wikipedia.org/wiki/Acute_renal_failurehttp://en.wikipedia.org/wiki/Acute_renal_failurehttp://en.wikipedia.org/wiki/Kidneyshttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Myocardial_infarction -
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lycogen phosphorylase isoenzyme is an isoenzymeof glycogen phosphorylase. This isoform of the
enzyme exists in cardiac (heart) and brain tissue.
The enzyme is one of the "new cardiac markers" which are
discussed to improve early diagnosis in acute coronarysyndrome.
A rapid rise in blood levels can be seen in myocardial infarctionand unstable angina.
Other enzymes related to glycogen phosphorylase areabbreviated as (liver) and (muscle).
Normal ranges
http://en.wikipedia.org/wiki/Isoenzymehttp://en.wikipedia.org/wiki/Glycogen_phosphorylasehttp://en.wikipedia.org/wiki/Cardiac_markerhttp://en.wikipedia.org/wiki/Acute_coronary_syndromehttp://en.wikipedia.org/wiki/Acute_coronary_syndromehttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Unstable_anginahttp://en.wikipedia.org/wiki/Unstable_anginahttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Acute_coronary_syndromehttp://en.wikipedia.org/wiki/Acute_coronary_syndromehttp://en.wikipedia.org/wiki/Cardiac_markerhttp://en.wikipedia.org/wiki/Glycogen_phosphorylasehttp://en.wikipedia.org/wiki/Isoenzyme -
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Normal ranges
Test Low High UnitComments
Sodium(Na) 136 145 mmol/L
Potassium(K) 3.5 4.5 mmol/L
Urea 2.5 6.4 mmol/L BUN - blood urea nitrogen
Urea 7 18 mg/dL
Creatininemale 62 115 mol/L
Creatininefemale 53 97 mol/L
Creatininemale 0.7 1.3 mg/dL
Creatininefemale 0.6 1.1 mg/dL
Glucose(fasting) 3.9 5.8 mmol/L See alsoglycosylated hemoglobin
Glucose(fasting) 70 105 mg/dL
http://en.wikipedia.org/wiki/Sodiumhttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Ureahttp://en.wikipedia.org/wiki/Blood_urea_nitrogenhttp://en.wikipedia.org/wiki/Ureahttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Glycosylated_hemoglobinhttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Glycosylated_hemoglobinhttp://en.wikipedia.org/wiki/Glycosylated_hemoglobinhttp://en.wikipedia.org/wiki/Glycosylated_hemoglobinhttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Ureahttp://en.wikipedia.org/wiki/Blood_urea_nitrogenhttp://en.wikipedia.org/wiki/Ureahttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Sodium -
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Thrombus
formation
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Functions
There are six functions:1. Transportation
O2lungscells
CO2 cellslungs
Nutrients GIcells
waste from cellskidneys
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Functions2. Defense
WBC disease
blood proteins antibodies
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Functions
3. Temperature regulation - absorbs anddistribute heat throughout body and skin
4. Prevents loss blood clots
5. Hormone movement
endocrine gland
cells
6. Regulates pH through buffers
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Imbalances (Disorders of
Hemostasis)
Thrombus clot that develops and persists in anunbroken vessel which can lead to thrombosis
where tissue/organ die because of obstruction(coronary thrombosis)
Embolism when small vessel is obstructed fromembolus .
Thrombocytopenia number of platelet isdeficient in blood
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Clinical Manifestation
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Myocardial Infarction
Lab Diagnostics
Cardiac Protein Troponin T
More sensitive than CK
Elevates 3 hr peak 24-48 hrs; normal 5-14 days
Cardiac Enzyme Creatine kinase (CK-MB)
Released when cardiac cells die
Elevates 3 hrs peak 12-24 hrs; normal 2-3 days
Cardiac Marker - MyoglobinFirst to elevate
Lacks cardiac specificity
Normal range within 24 hours
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For your attention
Thank you very much
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