الفهرس 
BIOCHEMICAL MARKERS OF MYOCARDIAL INJURYOnly 14 pages are availabe for public view
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Abstract
acute myocardial infarction, commonly known as a heart attack, is the interruption of blood supply to a part of the heart, causing heart cells to die. This is most commonly due to occlusion of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids and white blood cells in the wall of an artery. The resulting ischemia and oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death of heart muscle tissue .
The diagnosis of acute myocardial infarction is based on clinical symptoms, ECG changes and characteristic pattern of changes in some serum enzymes such as creatine kinase , CKMB, lactate dehydrogenase isoenzyme1 (LD1) and cardiac specific proteins like troponins .Since the clinical symptoms are not very reliable, ECG is the most widely used method of the diagnosis of myocardial infarction. But many times ECG shows inconclusive pattern. In such a situation the importance of serum biochemical markers of myocardial injury arises to confirm the diagnosis of myocardial injury.
Presently, troponin I or T, used alone or in combination with CK-MB or myoglobin, are the only markers accepted as part of the standard evaluation for acute coronary syndrome. Unfortunately, these biomarkers are elevated only after irreversible myocardial damage has occurred. Biomarkers that provide real-time assessment of the early inflammatory, ischemic, and thrombotic processes occurring at the molecular and cellular level are preferable. In this context, three new biomarkers have shown potential for development as bedside tests of global atherosclerotic plaque vulnerability and atherothrombosis: myeloperoxidas , ischemia modified albumin, and growth differentiation factors-15.
B-type natriuretic peptide (BNP) and N-terminal pro B-type natriuretic peptide are rapidly assayed serum biomarkers synthesized and secreted by the ventricular cardiomyocytes in response to ventricular stretching.Natriuretic peptides are considered quantitative markers of heart failure and/or cardiac wall stress that summarize the extent of left and right ventricular dysfunction as well as valvular dysfunction.The use of natriuretic peptide has been shown to be very helpful to confirm or rule out the diagnosis of heart failure in patients with acute dyspnea in the emergency department as well as for risk stratification.