Cardiac Biomarkers

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Author: Mary Ellen Koenn, MS, MLS(ASCP)
Reviewer: Kevin F. Foley, PhD, DABCC, MT, SC

Each year in the US alone, over one million individuals are diagnosed with an acute myocardial infarction (AMI) and approximately one half of these have had an AMI in the past. However, as many as 1 - 5% of patients with an AMI are misdiagnosed in the emergency department and are discharged. Rapid diagnosis of acute myocardial infarction is vital and laboratory testing that is sensitive and specific is essential. Upon completion of this course, you will be able to identify the characteristics of an optimal cardiac biomarker and discuss the laboratory tests that are most useful for rapid diagnosis and monitoring of ischemic heart disease and heart failure.

Continuing Education Credits


  • Describe the role of cardiac biomarkers, the characteristics of a good marker of cardiac disease, and the use of cardiac biomarkers today.
  • Explain atherosclerosis as an inflammatory process.
  • Compare and contrast the cardiac biomarkers cTnI and cTnT.
  • Discuss the utilization of CK-MB, myoglobin, and CK-isoform measurement in diagnosis of an acute myocardial infarction.
  • Describe the formation of BNP and NT-ProBNP and their role as markers of congestive heart failure.
  • Interpret the measurement results of cardiac biomarker assays in the diagnosis of an acute myocardial infarction and congestive heart failure.
  • Explain the role of cardiac biomarkers in risk stratification of those with heart disease.

Course Outline

  • Cardiac and Vascular Disease
      • Introduction
      • Organizations and Agencies
      • The Human Heart
      • Which heart chamber pumps oxygenated blood out to the body?
      • Terminology Describing Ischemic Heart Disease and Heart Failure
      • Acute Coronary Syndrome
      • Risk Factors for Heart Disease
      • Ischemia refers to necrotic tissue caused by an infarcted blood supply.
      • Congestive heart failure (CHF) ordinarily results when the left ventricular myocardium is weakened.
      • Atherosclerosis
      • Fibrous Cap
      • Lipids
      • Monitoring Lipids
      • A buildup of plaque that occurs with atherosclerosis may eventually lead to which of the following events?
  • Biomarkers of Cardiac Disease
      • Heart Disease and Cardiac Biomarkers
      • Uses of Cardiac Biomarkers
      • Optimal Cardiac Biomarkers
      • Current Cardiac Biomarkers
  • Biomarkers of An AMI
      • History
      • Troponins
      • Cardiac Troponin I (cTnI)
      • Cardiac Troponin T (cTnT)
      • Use of Troponins
      • Troponin Measurement and Ranges
      • Select the correct statements regarding troponins.
      • CK-MB
      • CK-MB Measurement and Ranges
      • Myoglobin
      • CK-Isoforms
      • Pattern of AMI Biomarker Levels
      • Diagnosis of an Acute Myocardial Infarction (AMI)
      • Guidelines for Cardiac Markers in AMI Diagnosis
      • Biomarker Sampling
      • High-Sensitivity Troponin
      • Which of the following cardiac biomarkers can be used as a stand-alone marker, and is therefore the preferred biomarker to indicate the presence of an...
      • A 62-year-old male has been brought by ambulance to the emergency department. The patient is a smoker with a history of uncontrolled hypertension. Whi...
      • While driving home after work, a 45-year-old male construction worker is involved in a collision with another car. Upon arrival in the emergency depar...
  • Biomarkers in CHF
      • Cardiac Biomarkers and Congestive Heart Failure (CHF)
      • Function of BNP
      • BNP Versus NT-ProBNP
      • BNP Versus NT-proBNP, continued
      • BNP and NT-ProBNP Measurement and Ranges
      • What is the function of the hormone, BNP?
      • A 79-year-old diabetic and retired homemaker lives alone since the death of her husband 5 years ago. At age 75, she was diagnosed with an AMI and had ...
  • Risk Stratification and Cardiac Biomarkers
      • Risk Stratification
  • Biomarkers to Identify Those at Risk for Developing Cardiac Disease
      • Other Cardiac Risk Markers
      • High Sensitivity C-Reactive Protein (hs-CRP)
      • Use of hs-CRP, Measurement, and Ranges
      • Comparisons of Concentrations of CRP and hs-CRP
  • References
      • References

Additional Information

Level of instruction: Intermediate

Intended Audience: Clinical laboratory technologists and technicians, and other health care personnel who have an interest in this subject matter. This course is also appropriate for medical laboratory science students and pathology residents.
Author information: Mary Ellen Koenn, MS, MLS(ASCP) is an associate professor emeritus, West Virginia University School of Medicine, Medical Laboratory Science Program. During her career as a medical technologist and educator, she has been a laboratory supervisor and manager and has held several teaching positions. She is the author of numerous articles for laboratory publications and textbook chapters and is a frequent presenter at laboratory seminars and workshops. Ms. Koenn holds a Master of Science degree in Medical Technology.
Reviewer information: Kevin F. Foley, PhD, DABCC, MT, SC is the Northwest chemistry, toxicology, immunology and POC director for Kaiser Permanente. He also teaches pharmacology, clinical chemistry, immunology and medicinal chemistry at Oregon Health Sciences University. Dr. Foley earned his PhD in clinical pharmacology and toxicology at East Carolina School of Medicine in North Carolina. His research areas include cardiovascular risk and inflammation markers as well as the neuropharmacology of amphetamine-like compounds. He is a frequent contributor to several clinical laboratory publications and is active in the American Association of Clinical Chemistry.

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