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Cardiac marker

**Elevation of levels of transaminase and lactic acid dehydrogenase (LDH)**
*Classification & external resources*
ICD-10	R74.0
ICD-9	790.4

Medical tests that are often referred to as cardiac markers include:

cardiac troponin (the most sensitive and specific test for myocardial damage)
creatine kinase (CK, also known as phosphocreatine kinase or creatine phosphokinase)
Aspartate transaminase (AST, also called Glutamic Oxaloacetic Transaminase (GOT/SGOT) or aspartate aminotransferase (ASAT))
lactate dehydrogenase (LDH)
Myoglobin (Mb) has low specificify for myocardial infarction and is used less than the other markers.

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Cardiac markers are substances released from heart muscle when it is damaged as a result of myocardial infarction. Depending on the marker, it can take between 2 to 24 hours for the level to increase in the blood. Additionally, determining the levels of cardiac markers in the laboratory - like many other lab measurements - takes substantial time. Cardiac markers are therefore not useful in diagnosing a myocardial infarction in the acute phase. The clinical presentation and results from an ECG are more appropriate in the acute situation.

Ischemia-Modified Albumin (IMA) can be detected via the albumin cobalt binding (ACB) test, a limited available FDA approved assay. Myocardial ischemia alters the N-terminus of albumin reducing the ability of cobalt to bind to albumin. IMA measures ischemia in the blood vessels and thus returns results in minutes rather than traditional markers of necrosis that take hours. ACB has low specificity therefore generating high number of false positives and must be used in conjunction with typical acute approaches such as ECG and physical exam. Additional studies are required.

v • d • e Abnormal clinical and laboratory findings (R70-R94, 790-796)
Blood test	red blood cells (Elevated ESR, Anisocytosis, Poikilocytosis, Reticulocytosis) - blood sugar (Abnormal glucose tolerance test, Hyperglycemia) - enzymes (Elevated transaminases, Cardiac marker) - elevated alpha-fetoprotein - mineral (Iron overload disorder) - pathogens (Bacteremia, Viremia) - Azotemia
Urine test	Proteinuria (Albuminuria, Microalbuminuria) - Glycosuria - Chyluria - Myoglobinuria - Bilirubinuria - Hemoglobinuria - Ketonuria - Crystalluria
Other	Abnormal basal metabolic rate