1. Cardiac Biomarkers in ACS
Telemetry
Course
Natalie Bermudez, RN, BSN, MS
Clinical Educator for Cardiac Telemetry

2. Cardiac Enzymes
A.K.A. ACP (Acute Cardiac Profile)
Normal Ranges:
CPK Total: 26 – 192
CK-MB: 0 – 3.60
Troponin I: 0 – 0.099
Normal < 0.10
Borderline 0.10 – 0.50
Abnormal (Critical Value) > 0.50

3. Cardiac Enzymes
Ordered for patients c/o chest pain and
suspected AMI
CE’s are drawn in sets of three 6 to 8
hours apart
Sometimes initial results are negative
CK-MB & Troponins are released within
hours of a cardiac event

4. CPK
Creatine Kinase Total
Rises within 3 - 12 hours after an AMI
Peak @ 24 hours
Return to normal within 48 – 72 hours
(Davis, 2004, p. 102)

5. Cardiac Enzymes
CPK
Creatine Kinase Total
• Most facilities have the ability to measure
this lab
• Highly sensitive for MI diagnosis but not
very specific (many false negatives)
• Should not be the sole lab value used to
confirm diagnosis
(Davis, 2004, p. 102)

6. CK-MB
Creatine Kinase Isoenzyme
Rise within 3 - 12 hours after an AMI
Peak @ 24 hours (6x > normal)
Return to normal within 48 – 72 hours
(Moser & Riegel, 2008, p. 792)

7. CK-MB
• Readily available
• Point of Care Testing available
• Highly sensitive but not as specific as
other tests
• May be falsely elevated by trauma,
surgery, hypothermia, DKA, seizures,
intramuscular injections, stroke, or
strenuous exercise
(Moser & Riegel, 2008, p. 792)

8. Troponin I
Rises within 3 – 12 hours of an
AMI
Peaks at 24 hours
Normalizes within 5 – 10 days
Preferred cardiac enzyme in
diagnosis of an AMI
(Moser & Riegel, 2008, p. 792)

9. Troponin I
Excellent sensitivity & specificity
• Point of Care Testing Available
• Not influenced by skeletal muscle
disease or renal disease
(Moser & Riegel, 2008, p. 792)

10. CE’s & Critical Values
Lab will call nursing for critical lab
values
Physician needs to be notified
immediately for Troponin > 0.50
Document in the “MD Notification &
Critical Values” structured note in
eCOS

11. Cardiac Enzymes
Patients with elevated CE’s usually
undergo a stress test and/or cardiac
catheterization for further
investigation of cause of chest pain.

12. References
Davis, L. (2004). Cardiovascular nursing secrets. St. Louis, MO:
Elsevier Mosby.
Kee, J. L. (2005). Laboratory and diagnostic tests with nursing
implications (7th ed.). Upper Saddle River, NJ: Pearson Prentice
Hall.
Kee, J. L. & Paulanka, B. J. (2000). Handbook of fluid, electrolyte, and
acid-base imbalances. Scarborough, Canada: Delmar Publishers.
Moser, D. K., & Riegel, B. (2008). Cardiac nursing: A compnion to
braunwald’s heart disease. St. Louis, MO: Saunders Elsevier.
Smeltzer, S. C. et al. (2008). Brunner and suddarth’s textbook of
medical-surgical nursing (11th ed.). Philadelphia, PA: Lippincott
Williams and Wilkins.
Taber’s On-Line Medical Dictionary