1. Supervised by: Associate professor: Dr. Alaa Abdel Salam Dr. Alaa Abdel Salam Done by:- Done by:- Asma Al – Rashoud Asma Al – Rashoud 421037300 421037300 Supervised by: Associate professor: Dr. Alaa Abdel Salam Done by:- Asma Al – Rashoud 421037300

2. ” قَالُواْ سُبْحَانَكَ لاَ عِلْمَ لَنَآ إلاَّ مَا عَلّمْتَنَا إِنَّكَ أَنْتَ الْعَلِيِمُ الْحَكِيِمُ “ آيه 32 سورة البقرة سورة البقرة ” قَالُواْ سُبْحَانَكَ لاَ عِلْمَ لَنَآ إلاَّ مَا عَلّمْتَنَا إِنَّكَ أَنْتَ الْعَلِيِمُ الْحَكِيِمُ “ آيه 32 سورة البقرة سورة البقرة

3. Enzymes are specific biologically synthesized protein that catalyze biochemical reactions Enzymes are specific biologically synthesized protein that catalyze biochemical reactions Cardiac enzymes are those enzymes which found in the heart muscle with variable values. Cardiac enzymes are those enzymes which found in the heart muscle with variable values. Cardiac enzyme levels are obtained to determine the presence or absence of some pathological conditions such as AMI. Cardiac enzyme levels are obtained to determine the presence or absence of some pathological conditions such as AMI. Exercise training effects the cardiovascular and skeletal muscle systems in a variety of ways to improve work performance. Exercise training effects the cardiovascular and skeletal muscle systems in a variety of ways to improve work performance.

4. 1. To provide sufficient information about cardiac enzymes 2. To expose the relationship between cardiac enzymes and some pathological conditions 3. To identify the effect of exercise on cardiac enzymes

6. EnzymesEnzymes Definition Definition Enzymes are functional proteins that act as biological catalysts. Enzyme activity Enzyme activity Enzyme nature Enzyme nature Enzyme structure Enzyme structure *Primary structure * Secondary structure *Tertiary structure* Quaternary structure

7. Enzyme levels can help provide evidence of disease process. Enzyme levels can help provide evidence of disease process. Indicate the location of the abnormality. Indicate the location of the abnormality. Assess the extent and severity of the illness. Assess the extent and severity of the illness. Identify the probable cause of the condition Identify the probable cause of the condition Enzyme Values are usually expressed in terms of activity. Enzyme Values are usually expressed in terms of activity.

8. Factors Influence Enzymatic Reactions Substrate concentration Substrate concentration Enzyme concentration Enzyme concentration pH pH Temperature Temperature Cofactors Cofactors Inhibitors Inhibitors

9. Cardiac Enzymes 1-Creatine Kinase ( CK ) 2- Lactic Dehydrogenase (LD) 3-Aspartate aminotransferase (AST), also called glutamic – oxaloacetic transaminase ( GOT ). 4-Alanine aminotransferase (ALT), also called glutamic – pyruvic transaminase (GPT) 5- Hydroxybutyric dehydrogenase ( HBD ) 5- Hydroxybutyric dehydrogenase ( HBD )

10. Creatine Kinase Creatine Kinase Tissue Source – H– H– H– Higher Values found in skeletal muscle, heart muscle and brain tissue, –S–S–S–Smaller quantities in bladder, gastrointestinal tract, thyroid, lung, liver and pancreas. CK Isoenzymes – C– C– C– Ck – MM – C– C– C– CK – BB – C– C– C– CK – MB CK Values –4–4–4–40 to 175 U/L for men. –2–2–2–25 to 140 U/L for women.

11. Lactate Dehydrogenase (LD) Lactate Dehydrogenase (LD) Tissue Sources – H– H– H– High Activities are found in the heart, the liver, skeletal muscle, the kidney and red blood cells. –L–L–L–Lesser amount in the lung, smooth muscle and the brain. LD Isoenzyme – L– L– L– LD -1 –L–L–L–LD – 2 –L–L–L–LD – 3 –L–L–L–LD – 4 –L–L–L–LD – 5 LD values –T–T–T–Total LDH levels normally rang from 48 to 115 U/L.

12. Isoenzyme Relationship in Normal Pattern

13. Asparate Aminotransferase Asparate Aminotransferase Tissue Source – H– H– H– Highest Concentration are found in cardiac tissue, the liver and skeletal muscle. –S–S–S–Smaller amounts found in the kidney, the pancreas, and red blood cells. Values – A– A– A– AST Levels range from 8 to 20 U/L

14. Alanine Aminotransferase Alanine Aminotransferase Tissue Source –I–I–I–Is found in high concentrations in the liver. Values –R–R–R–Range from 10 to 32 U/L in women. – R– R– R– Range from 9 to 24 U/L in men.

15. Hydroxybutyric Dehydrogenase ( HBD ( Hydroxybutyric Dehydrogenase ( HBD ( Tissue Source –(–(–(–( HBD ) is found in highest concentrations in heart muscle, kidney, brain and red blood cells. Values –(–(–(–( HBD ) vales rang from 114 to 290 U/L

16. Relation between Cardiac Enzymes and Heart Disease Myocardial Infarction Definition Myocardial infarction: condition caused by partial or complete occlusion of one more coronary arteries.

17. Relationship between Cardiac Enzymes and AMI After an infarction the serum activity of CK is increased from about 6 – 72 hours with a peak at 24 hours. After an infarction the serum activity of CK is increased from about 6 – 72 hours with a peak at 24 hours. LD is increased from 1 to 10 days after infarction, with a peak at 2 days. LD is increased from 1 to 10 days after infarction, with a peak at 2 days. AST is elevated from about 0.5 to 5 days with a peak at 24 hours. AST is elevated from about 0.5 to 5 days with a peak at 24 hours. HBDH levels begin to rise 8 – 10 days following M.I with peak levels about 48 – 96 hours. HBDH levels begin to rise 8 – 10 days following M.I with peak levels about 48 – 96 hours.

18. Effect of Exercise on the Body Circulatory System Circulatory System –Heart rate – Cardiac output –Systolic blood pressure – Coronary blood flow –Diastolic blood pressure – Muscle blood flow Respiratory System Respiratory System –Oxygen uptake –Stork Volume –Ventilation –Respiratory Rate Musculoskeletal System Musculoskeletal System –Muscle Strength –Bone Mass

19. CK levels may be elevated for as long as 48 hours following exercise. CK levels may be elevated for as long as 48 hours following exercise. The predominant isoenzyme is CK-MM. The predominant isoenzyme is CK-MM. LDH increased in the period following exercise with a rapid rise and fall. LDH increased in the period following exercise with a rapid rise and fall. AST increased following exercise. AST increased following exercise. ALT increased after exercise. ALT increased after exercise.

21. To the technician: when you perform cardiac enzymes test to patient already made exercise you must be keep in your mind the result of the test will be come higher than the realistic values. To the technician: when you perform cardiac enzymes test to patient already made exercise you must be keep in your mind the result of the test will be come higher than the realistic values. To the physical therapist: you must be encourage your patient to do exercise prudently within his endurance since the benefits of exercise exceed the risks To the physical therapist: you must be encourage your patient to do exercise prudently within his endurance since the benefits of exercise exceed the risks

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