Lecture on Cardiac Biomarkers and Treatment

Troponin as a Cardiac Biomarker

Troponin is the cornerstone for cardiac biomarker tests.
- Most specific for heart injury compared to other tests.
- Remains elevated longer during a heart injury.
- Two types: Troponin I and Troponin T.
High Sensitivity Troponin
- Newer test with different values.
- Can detect over 50% of myocardial infarction cases at admission.
- Useful for patients presenting late after symptom onset.
- Normal levels are below 14; typical troponin levels: 0 to 0.04.

CPK (Creatine Phosphokinase)
- Not specific; indicates general muscle damage.
- CK-MB (CPK-2) is more specific for cardiac damage.
- Rises in 4-8 hours, peaks at 12-24 hours, normalizes in 2-3 days.
LDH (Lactate Dehydrogenase)
- Less specific compared to troponin.

Patient Assessment
- Position patient in semi-Fowler's.
- Oxygen to maintain saturation above 94% (NCLEX recommends treatment at 94% or lower).
Medications
- Aspirin: Chewed and swallowed for platelet aggregation.
- Nitroglycerin: For chest pain relief; decreases preload and afterload, mainly a venous vasodilator.
Analgesics
- Morphine or Fentanyl (preferable due to fewer hemodynamic issues).

Thrombolytics
- Ideal within 6 hours of chest pain; best within 30 minutes.
- TNK (Techno place): Main drug for myocardial infarction.
- Risk of bleeding, including potential brain hemorrhage.
Post-MI Medication
- Continued medications for platelet aggregation (e.g., Plavix, Heparin, beta blockers).
- Beta blockers should be cardio-selective (e.g., Metoprolol).

Monitoring
- EKG monitoring for PVCs.
- Vital signs and bed rest initially.
Diet and Lifestyle
- Avoid high-sodium foods initially.
- Progressive ambulation post-MI, cardiac rehab recommended.
Long-term Considerations
- Education on CPR for family.
- Discussion on resuming activities like sex; generally safe when patient can handle moderate exertion.
- Avoid erectile dysfunction drugs while on nitroglycerin.