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Cardiac Enzymes

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- CPK:
    - normal values:
            - men: less than 174 Units/liter
            - women: less than 140 Units/liter
            - isoenzymes: MM 100%, MB (cardiac) and BB (brain) normally comprise 0%;
    - abnormal values:
            - myocardial infarct
                   - CPK levels begin to rise 4-6 hours after MI has started and reaches its peack values within 30 hrs;
                   - look for an elevation of the CPK MB isoenzymes at 4-6 hours (in MI the CPK MB is more than 5% of total CPK);
            - post surgical elevation: there will be an elevation of the CPK level, but the CPK MB percentage should be close to 0;
            - polymyositis

- Troponin I and T:
    - these are cardiac specific muscle proteins which are elevated with cardiac muscle damage;
    - may also be elevated with pulmonary embolism
    - references:
            - Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I.
            - A proposed strategy for utilization of creatine kinase-MB and troponin I in the evaluation of acute chest pain.

Serum creatine kinase and lactate dehydrogenase changes after anterior approaches to the thoracic and lumbar spine.

Serum CK-MB is useful in diagnosis of acute myocardial infarction after total hip arthroplasty.

Cardiac isoenzyme values after total joint arthroplasty.

Creatine kinase MB in skeletal muscle and serum of spine-fusion patients.

Perioperative creatine phosphokinase (CPK) and troponin I trends after elective hip surgery.

Neuromuscular Symptoms and Elevated Creatine Kinase after Statin Withdrawal

19 Oregon football players treated for rare muscle injury

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