Supervised by:Supervised by:

Associate professor:Associate professor:

Dr. Alaa Abdel SalamDr. Alaa Abdel Salam

Done by:-Done by:-

Asma Al – RashoudAsma Al – Rashoud

421037300421037300

Supervised by:Supervised by:

Associate professor:Associate professor:

Dr. Alaa Abdel SalamDr. Alaa Abdel Salam

Done by:-Done by:-

Asma Al – RashoudAsma Al – Rashoud

421037300421037300

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البقرة البقرة سورة سورة

ال�” ان�ك� ب�ح� س الوا� ال�” ق� ان�ك� ب�ح� س الوا� ق�ع�ل�م�ت�ن�ا م�ا إال� ل�ن�آ ل�م� ع�ل�م�ت�ن�ا ع� م�ا إال� ل�ن�آ ل�م� ع�

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البقرة البقرة سورة سورة

• Enzymes are specific biologically synthesized Enzymes are specific biologically synthesized protein that catalyze biochemical reactions protein that catalyze biochemical reactions

• Cardiac enzymes are those enzymes which Cardiac enzymes are those enzymes which found in the heart muscle with variable values.found in the heart muscle with variable values.

• Cardiac enzyme levels are obtained to Cardiac enzyme levels are obtained to determine the presence or absence of some determine the presence or absence of some pathological conditions such as AMI.pathological conditions such as AMI.

• Exercise training effects the cardiovascular and Exercise training effects the cardiovascular and skeletal muscle systems in a variety of ways to skeletal muscle systems in a variety of ways to improve work performance. improve work performance.

1.1. To provide sufficient information To provide sufficient information about cardiac enzymesabout cardiac enzymes

2.2. To expose the relationship between To expose the relationship between cardiac enzymes and some cardiac enzymes and some pathological conditions pathological conditions

3.3. To identify the effect of exercise on To identify the effect of exercise on cardiac enzymescardiac enzymes

EnzymesEnzymes EnzymesEnzymes

• DefinitionDefinition

Enzymes are functional proteins Enzymes are functional proteins that act as biological catalysts.that act as biological catalysts.

• Enzyme activityEnzyme activity

• Enzyme natureEnzyme nature

• Enzyme structure Enzyme structure ** Primary structurePrimary structure * Secondary structure * Secondary structure

** Tertiary structureTertiary structure * Quaternary structure* Quaternary structure

• Enzyme levels Enzyme levels can help provide evidence can help provide evidence of disease process.of disease process.

• Indicate the location of the abnormality.Indicate the location of the abnormality.

• Assess the extent and severity of the Assess the extent and severity of the illness.illness.

• Identify the probable cause of the Identify the probable cause of the conditioncondition

• Enzyme Values Enzyme Values are usually expressed in are usually expressed in terms of activity.terms of activity.

Factors Influence Factors Influence Enzymatic ReactionsEnzymatic ReactionsFactors Influence Factors Influence Enzymatic ReactionsEnzymatic Reactions

•Substrate concentrationSubstrate concentration

•Enzyme concentrationEnzyme concentration

•pHpH

•Temperature Temperature

•Cofactors Cofactors

•InhibitorsInhibitors

Cardiac EnzymesCardiac EnzymesCardiac EnzymesCardiac Enzymes

1-1- Creatine Kinase (Creatine Kinase ( CK CK ))2- Lactic Dehydrogenase (2- Lactic Dehydrogenase (LDLD))3-3- Aspartate aminotransferase (Aspartate aminotransferase (ASTAST), ), also also called glutamic – oxaloaceticcalled glutamic – oxaloacetic transaminase (transaminase ( GOT GOT ).).4-4- Alanine aminotransferase (Alanine aminotransferase (ALTALT), also), also

called glutamic – pyruvic called glutamic – pyruvic transaminasetransaminase ((GPTGPT))

5- 5- Hydroxybutyric dehydrogenase (Hydroxybutyric dehydrogenase ( HBDHBD ))

Creatine KinaseCreatine KinaseCreatine KinaseCreatine Kinase

• Tissue SourceTissue Source– Higher Values Higher Values found in skeletal muscle, heart found in skeletal muscle, heart

muscle and brain tissue,muscle and brain tissue,– Smaller quantitiesSmaller quantities in bladder, gastrointestinal tract, in bladder, gastrointestinal tract,

thyroid, lung, liver and pancreas. thyroid, lung, liver and pancreas.

• CK IsoenzymesCK Isoenzymes– Ck – MMCk – MM– CK – BBCK – BB– CK – MBCK – MB

• CK Values CK Values – 40 to 175 U/L for men.40 to 175 U/L for men.– 25 to 140 U/L for women. 25 to 140 U/L for women.

Lactate Dehydrogenase Lactate Dehydrogenase (LD)(LD)Lactate Dehydrogenase Lactate Dehydrogenase (LD)(LD)• Tissue SourcesTissue Sources

– High ActivitiesHigh Activities are found in the heart, the liver, are found in the heart, the liver, skeletal muscle, the kidney and red blood cells.skeletal muscle, the kidney and red blood cells.

– Lesser amount Lesser amount in the lung, smooth muscle and the in the lung, smooth muscle and the brain.brain.

• LD IsoenzymeLD Isoenzyme– LD -1LD -1– LD – 2LD – 2– LD – 3 LD – 3 – LD – 4LD – 4– LD – 5LD – 5

• LD valuesLD values– Total LDH levels normally rang from 48 to 115 U/L.Total LDH levels normally rang from 48 to 115 U/L.

Isoenzyme Relationship in Isoenzyme Relationship in Normal PatternNormal PatternIsoenzyme Relationship in Isoenzyme Relationship in Normal PatternNormal Pattern

0

10

20

30

40

50

60

70

80

90

LD 1 LD 2 LD 3 LD 4 LD 5

LD 1

LD 2

LD 3

LD 4

LD 5

Asparate Asparate AminotransferaseAminotransferaseAsparate Asparate AminotransferaseAminotransferase

• Tissue SourceTissue Source– Highest Concentration Highest Concentration are found in are found in

cardiac tissue, the liver and skeletal cardiac tissue, the liver and skeletal muscle.muscle.

– Smaller amountsSmaller amounts found in the found in the kidney, the pancreas, and red blood kidney, the pancreas, and red blood cells.cells.

• ValuesValues– AST Levels range fromAST Levels range from 8 to 20 U/L 8 to 20 U/L

Alanine Alanine AminotransferaseAminotransferase Alanine Alanine AminotransferaseAminotransferase

• Tissue SourceTissue Source – Is found in high concentrations in Is found in high concentrations in

the liver.the liver.

• Values Values – Range from 10 to 32 U/L in women.Range from 10 to 32 U/L in women.– Range from 9 to 24 U/L in men.Range from 9 to 24 U/L in men.

Hydroxybutyric Hydroxybutyric Dehydrogenase ( HBDDehydrogenase ( HBD ( (Hydroxybutyric Hydroxybutyric Dehydrogenase ( HBDDehydrogenase ( HBD ( (• Tissue SourceTissue Source

– ( HBD ) is found in highest ( HBD ) is found in highest concentrations in heart muscle, concentrations in heart muscle, kidney, brain and red blood cells.kidney, brain and red blood cells.

• Values Values – ( HBD ) vales rang from 114 to 290 ( HBD ) vales rang from 114 to 290

U/LU/L

Relation between Cardiac Relation between Cardiac Enzymes and Heart DiseaseEnzymes and Heart Disease• Myocardial InfarctionMyocardial Infarction

DefinitionDefinition

Myocardial infarction: condition Myocardial infarction: condition caused by partial or complete caused by partial or complete occlusion of one more coronary occlusion of one more coronary arteries. arteries.

Relationship between Cardiac Relationship between Cardiac Enzymes and AMIEnzymes and AMI

• After an infarction the serum activity of CK is After an infarction the serum activity of CK is increased from about 6 – 72 hours with a peak increased from about 6 – 72 hours with a peak at 24 hours.at 24 hours.

• LD is increased from 1 to 10 days after LD is increased from 1 to 10 days after infarction, with a peak at 2 days.infarction, with a peak at 2 days.

• AST is elevated from about 0.5 to 5 days with AST is elevated from about 0.5 to 5 days with a peak at 24 hours.a peak at 24 hours.

• HBDH levels begin to rise 8 – 10 days following HBDH levels begin to rise 8 – 10 days following M.I with peak levels about 48 – 96 hours.M.I with peak levels about 48 – 96 hours.

Effect of Exercise on the Effect of Exercise on the BodyBody

Effect of Exercise on the Effect of Exercise on the BodyBody

• Circulatory System Circulatory System – Heart rate Heart rate – – Cardiac outputCardiac output– Systolic blood pressure Systolic blood pressure – – Coronary blood flowCoronary blood flow– Diastolic blood pressure Diastolic blood pressure – – Muscle blood flowMuscle blood flow

• Respiratory System Respiratory System – Oxygen uptakeOxygen uptake– Stork VolumeStork Volume– VentilationVentilation– Respiratory RateRespiratory Rate

• Musculoskeletal System Musculoskeletal System – Muscle Strength Muscle Strength – Bone MassBone Mass

• CK levels may be elevated for as long CK levels may be elevated for as long as 48 hours following exercise.as 48 hours following exercise.

• The predominant isoenzyme is CK-MM.The predominant isoenzyme is CK-MM.

• LDH increased in the period following LDH increased in the period following exercise with a rapid rise and fall.exercise with a rapid rise and fall.

• AST increased following exercise.AST increased following exercise.

• ALT increased after exercise.ALT increased after exercise.

• To the technicianTo the technician: when you perform : when you perform cardiac enzymes test to patient already cardiac enzymes test to patient already made exercise you must be keep in your made exercise you must be keep in your mind the result of the test will be come mind the result of the test will be come higher than the realistic values.higher than the realistic values.

• To the physical therapistTo the physical therapist: you must be : you must be encourage your patient to do exercise encourage your patient to do exercise prudently within his endurance since the prudently within his endurance since the benefits of exercise exceed the risksbenefits of exercise exceed the risks

• To the patient:To the patient: you have to do you have to do exercise to improve your exercise to improve your performance.performance.