TROPONINDr HUO TAOMEDICAL RESIDENT课件.pptVIP

TROPONINDr HUO TAOMEDICAL RESIDENT 2012-12-18 What is troponin Troponin is a complex of three regulatory proteins that is integral to non-smooth muscle contraction in skeletal as well as in cardiac musles. Troponin is attached to the tropomyocin sitting in the groove between actin filaments in muscle tissue. Three types of troponins exist—troponin I, troponin T, and troponin C. Each subunit has a unique function: Troponin T binds the troponin components to tropomyosin, troponin I inhibits the interaction of myosin with actin, and troponin C contains the binding sites for Ca2+ that helps initiate contraction. How much available in cardiac muscle Troponin T 10.8 mg/g wet weight Troponin I 5 mg/g wet weight CK – MB 1.4 mg/g wet weight The difference between TnT TnI Determining infarct size Peak troponin values can provide an estimate of the infarct size and the severity of myocardial damage. These values are more sensitive in the setting of transmural infarction (ST-segment–elevation MI [STEMI]) than in subendocardial infarctions (NSTEMI). This correlation holds true for both troponin T and troponin I (peak or values at 72-96 hours). Higher values generally correlate with a larger infarct What else cause troponin elevation 4. In patients with background elevations of TnT (e.g. patients with CRF), two measurements are required to demonstrate a rising pattern.5. No single serum marker used alone has sufficient sensitivity or specificity to reliably identify or exclude AMI within 6 hours after symptom onset.6. Discontinue the routine measurement of myoglobin, CK, and CK-MB as cardiac markers for the rule-out of AMI in the ED.7 Do not utilize cardiac serum marker tests to exclude unstable angina.8. Document the time of onset of chest pain on all patients. The tubes in which the sample is collected are different for troponin T and troponin I, and the clinician should refer to the package insert for requirement