CARDIAC ENZYMES

A. DEFINITION
Special proteins that catalyze chemical reactions in living cells. Present in high concentrations in myocardial tissue. proteins from heart muscle cells that are released into the bloodstream when heart muscle is damaged, such as during a myocardial infarction (MI).

CARDIAC ENZYME STUDIES

measure the levels of the enzyme creatine phosphokinase (CPK, CK) and the protein troponin (TnI, TnT) in the blood. must always be compared with the patients symptoms, physical examination findings, and electrocardiogram (EKG, ECG) results.

B. INDICATIONS/CONTRAINDICATIONS INDICATIONS:
Cardiac enzyme studies are done to:

Determine whether you are having a heart attack or a threatened heart attack (unstable angina) if you have chest pain, shortness of breath, nausea, sweating, and abnormal electrocardiography results. Check for injury to the heart after bypass surgery. Determine if a procedure, such as percutaneous coronary intervention (PCI), or a medicine to dissolve the blockage (thrombolytic medicine) has successfully restored blood flow through a blocked coronary artery.

CONTRAINDICATIONS:
Reasons you may not be able to have the test or why the results may not be helpful include:

Other diseases, such as muscular dystrophy, certain autoimmune diseases, and Reye syndrome. Other heart conditions, such as myocarditis and some forms of cardiomyopathy. Emergency measures to treat heart problems, such as CPR, cardioversion, or defibrillation. Medicines, especially injections into muscles (IM injections). Cholesterol-lowering medicines (statins). Heavy alcohol use. Recent strenuous exercise. Kidney failure. Recent surgery or serious injury.

C. MATERIALS/EQUIPMENTS
Syringe Elastic band Cotton balls with and without alcohol Hypoallergenic tape/plaster

D. PREPARATION
No special preparation is required before having this test.

E. PROCEDURE
1. Identify patient and explain the procedure and its purpose. 2. Draw blood from patient. 3. Wrap an elastic band around the upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein. 4. Clean the needle site with alcohol. 5. Put the needle into the vein. More than one needle stick may be needed. 6. Attach a tube to the needle to fill it with blood. 7. Remove the band from the arm when enough blood is collected. 8. Put a gauze pad or cotton ball over the needle site as the needle is removed. 9. Put pressure on the site and then put on a bandage.

F. PICTURE/ILLUSTRATION/DEMO

G. COMPLICATIONS RISKS
There is very little chance of a problem from having blood sample taken from a vein.

You may get a small bruise at the site. You can lower the chance of bruising by keeping pressure on the site for several minutes. In rare cases, the vein may become swollen after the blood sample is taken. This problem is called phlebitis. A warm compress can be used several times a day to treat this. Ongoing bleeding can be a problem for people with bleeding disorders. Aspirin, warfarin (Coumadin) and other blood-thinning medicines can make bleeding more likely.

H. NURSING RESPONSIBILITIES BEFORE

Explain to the patient the test and its purpose. Explain the procedure. Tell the patient that the procedure will not take long. Discuss test preparation, procedure, and posttest care. Inform patient that he need not to restrict food or fluids before the procedure.

DURING
Tell the patient to relax while the procedure is going on.

AFTER
Instruct the patient to put pressure on the site and to not remove the bandage until bleeding stops.