CKMB, Troponin

geekgolightly, BSN, RN · Sep 16, 2009

Okay, the hospital I work at uses these two labs when we have a patient on rule out for MI or ACS, vs the other hospital I worked at using troponins and myoglobin.
Can someone fill in the blanks for me here?
Elevated CKMB
Elevated Trop =___________ (+ MI or can this include ACS?)
Elevated CKMB
Normal Trop =____________ (no ACS, maybe other things, like rhabdo or something?)
Normal CKMB
Elevated Trop= ____________ (I know kidney function plays a role in trops, and I assume CKMB also?)
I'm trying to differentiate between angina, MI, or just a stressed heart (like CHF exacerbation, etc).

Elevated CKMB and troponin can be both. You need other testing like and EKG, physical exam, hx, relief with sl nitro to help differentiate between unstable angina and an mi. With CHF exacerbation, you look to the BNP and CXR.

elevated CKMB normal troponin can be rhabdo depending upon history of course. it can also be related to procedures or renal failure. it can even be nutrition or exercise related. any sort of damage to the muscles.

normal ckmb and elevated troponin. i think i remember that ckmb rises and falls rather quickly. troponin rises quick, but then stays elevated for a number of days. so it can be a cardiac episode that happened greater than a day or so.

geekgolightly, BSN, RN · Sep 16, 2009

i went and looked up the rise and fall to be sure.

ckmb will generally return to normal within 72 hours of injury and troponin stays elevated for up to 10 days.

http://www.labtestsonline.org/understanding/analytes/troponin/test.html

http://www.labtestsonline.org/understanding/analytes/ckmb/test.html

Mrs.FullerRN · Sep 17, 2009

Myoglobin is handy in an ER setting, if it is negative for at least 4 hours it can totally rule out MI but other injuries may be occuring.

preciosa · Sep 18, 2009

Troponin is more specific to heart injury and stays up longer ,that is why it is a reliable source to ruling in MI/ACS. The number depends on the hospital I guess.When I was in London

Manurse715 · Oct 1, 2009

Troponin is more specific to heart injury and stays up longer ,that is why it is a reliable source to ruling in MI/ACS. The number depends on the hospital I guess.When I was in London
All Americans eating burgers and fries everyday walk around with a + Trop of
Yeah Trops are really good because they rise soon and stay up there a while. Myoglobins are too sensitive and not very specific.
To add CK can be elevated with dead feet that need to get chomped, or after folks have seizures.

roxaneraquel · Oct 9, 2009

CK's can be elevated with ANY mucsle injury, ie fall, post ictal, post op CABG. MB is more sensitive to cardiac injury, however is rarely used as a marker for MI, ACS. Trop in conjunction with a rise in ck as well as presentation of the patients ecg is more specific for cardiac injury. Keep in mind that TROP. on its own should not be an indicator for MI , as can be elevated in patients with renal disease, CHF, Pulmonary disease ect.