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The modern preventive medicine aims to make screening of the population in order to discover those with risk to develop a certain disease, in other words, to find those where the process has been already started, but has not been accompanied with symptoms. Today, the risk of occurrence of cardiovascular events can be interpreted as a result of many laboratory parameters which allow taking preventive actions on time.

What are cardiac markers?

Cardiac markers also known as cardiac biomarkers, are substances that are released into the blood and whose concentration is measured in order to assess the proper function of the heart.

Why are they measured?

The measurement of cardiac markers helps in risk assessment, diagnosis, monitoring and dealing with heart problems, enabling rapid initiation of preventive and therapeutic actions.

Avicena Laboratory offers modern high-sensitive tests form Siemens Healthcare Diagnostics inconcordance with the ESC (European Society of Cardiology) and ACC (American College of Cardiology Foundation) for determination of the concentration of all important cardiac markers inthe blood.

High sensitive C – reactive protein (hsCRP)

hsCRP is an acute phase protein that occurs in the circulation in response to inflammatory cytokines (such as interleukin-6) and a marker of systemic inflammation. It is an important indicator of inflammation, necrosis or tissue trauma.

► hsCRP is a predictor for the occurrence of cardiovascular disorder in adults with no previous history of disease existence.

► hsCRP enhances risk assessment and response to therapy in the primary prevention of cardiovascular disease.

Тhe reference values of plasma hsCRP are less than 3,0 mg/L.

Тhe hsCRP test performs quantitative analysis of very low levels of CRP in the blood. Classic CRP tests can’t detect the level of CRP that is associated with the development of cardio-vascular diseases. The hsCRP test can detect these low concentrations. It is a test which is increasingly used as a marker for assessing the risk of cardiovascular diseases, as well as prognostic marker in an existing heart diseases.

Along with the evaluation of lipid status and scoring systems for determining risk, hsCRP test is necessary in evaluating the risk for cardiovascular diseases.

Creatinin Kinase – CK

CK-MB

In clinical practice, the quantitative determination of CK in serum is used as a marker for myocardial infarction and skeletal muscles disease.

The concentration of CK-MB as a marker of early myocardial damage grows 2-6 hours after the attack, and can goes up to 2-3 days after a heart attack.

Reasons for increased values:

1. Miocardial Infarction

2. Miocarditis

3. Pericarditis

4. Muscular dystrophy

5. Heart surgery

6. Strenuous exersise – traning

7. Mixed connective tissue disease

8. Cardiomyopathy

9. Hypothermia

Reference values: up to 5.3 IU/L

Troponin

Quantitative determination of troponin I in serum is used as a marker of myocardial necrosis and acute myocardial infarction, for identification of high risk patients and monitoring of the condition, confirms the need for more aggressive treatment, for distinguishing angina pectoris and myocardial infarction in patients with chest pain.

During myocardial infarction, the cardiac troponin remain elevated 10-14 days after cardiac damage.

Troponin levels in the blood remain elevated longer than levels of a CK-MB or MYO, allowing an extended diagnostic window for myocardial infarction.

Reference values: less than 1,0 ng/ml

Cholesterol is a steroid compound which forms with the breakdown of the fat in our body. Since cholesterol takes part in the formation of the bile acid, sex hormones and hormones of the adrenal gland, it is essential for the normal functioning of the body.

Cholesterol is carried in the blood by proteins in the plasma, building a biochemical complex called lipoprotein.

There are two types of lipoproteins:

• low-density lipoprotein i.e. “bad” cholesterol (LDL), lipoproteins which carry high concentration of cholesterol; and

• „good“cholesterol (HDL) – lipoproteins which carry low concentration of cholesterol.

LDL carries cholesterol in the blood vessels, forming an atheromatous plaques within the arteries that cause narrowing of the lumen of the blood vessels, thus leading to heart, brain and other diseases.

HDL, in turn, improves the elasticity of the blood vessels, hence its deficiency in the body makes blood vessels non-elastic and stiff. Almost two-thirds of the cholesterol is synthesized in the liver (800-900 mg) and only 1/3 is directly ingested through food.

Atherosclerosis

Atherosclerosis is a process of accumulation of fat on the inner walls of large and medium-sized arteries. At the beginning, they are small crystals of cholesterol, which gradually create deposits (plaque) that narrow the lumen of the blood vessel. Subsequently, scarring and hardening of the wall of blood vessels occurs, making them more prone to rupture. These changes of the inside of the blood vessel lead to blood clots or lead to a condition known as thrombosis.

There are several causes of atherosclerosis, but increased concentration of cholesterol in the form of low density lipoprotein (LDL) is the most common one. Factors leading to an increased risk of developing atherosclerosis fall into two groups: – Modifying factors- smoking, physical activity, diet, etc.- Non-modifying factors– gender, age, genetic factors -Other factors – diabetes, obesity, elevated levels of LDL, homocysteine, triglycerides, uric acid and other substances in the blood, hyperthyroidism, and other conditions.

What is considered a high blood cholesterol level?

For healthy people, with no family history of heart disease, the level of total cholesterol in the blood should not be higher than 5.2 mmol/l, whereas HDL should be higher than 1 mmol/l and LDL less than 3 mmol/l. Any cholesterol level over these reference values (especially LDL cholesterol) increases the risk of heart disease.

Do men and women have the same risk of high cholesterol?

Can increased levels of cholesterol cause a heart attack? The increased level of cholesterol is the most common cause of heart attack. On its own, increased cholesterol levels do not cause symptoms, but it is the major risk factor for atherosclerosis, which in turn can cause a heart attack. Therefore, in people with heart disease, the level of LDL cholesterol in the blood must not exceed 2.5 mmol/l.

Is increased body weight always a sign of increased level of cholesterol in the blood?

The increased level of cholesterol in the blood is not always related to increased body weight. It is a big misconception that only people with increased body weight have increased cholesterol in the blood. Many people have high cholesterol as a result of genetic-hereditary predisposition, although they might have normal weight or even be thin. However, most people with increased body weight have higher levels of cholesterol. About half of the patients have elevated blood cholesterol levels as a result of inadequate diet, and in the other half, the cause is their genetic predisposition. All products of animal origin: eggs (yolk), liver, brain, butter, sour cream, red meat, cured meat products, and semi fat cheeses contain saturated fatty acids, which increase the level of LDL cholesterol in the blood. Therefore, a healthy diet with fresh fruits and vegetables, regular physical activity, terminating the smoking habit, and stress reduction are essential factors in maintaining normal levels of blood cholesterol.

Blood is a tissue composed of three types of cells – erythrocytes (red blood cells), leukocytes (white blood cells) and thrombocytes (platelets). Erythrocytes contain red and iron rich protein – hemoglobin (Hb), which carries oxygen from the lungs to all the muscles and organs in our body. Normal life and normal functioning is impossible without oxygen.

Anemia is a condition of a red blood cells deficiency (or lack of hemoglobin). In this case, a small number of erythrocytes contain low levels of hemoglobin, which results in decreasing of oxygen transported to organs such as the brain, heart, and muscles. Therefore, when one is anemic he/she displays signs of mental and physical weakness. When the number of erythrocytes is reduced the heart works faster in order to compensate for the lack of oxygen, i.e. increased blood flow compensates for the lack of oxygen in the erythrocytes depleted blood.

Possible causes:

›          Blood loss, either as a result of menstrual cycle or various kidney diseases, joints, blood-forming organs, parasitic infections, and etc.

›          Medication side effects.

›          Inadequate nutrition and lack of vitamins, iron, ect.

Anemia is sometimes difficult to diagnose, because the early symptoms are too mild. As a result of that, it is easily confused with symptoms of other diseases or as a side effect of some medication. Anemia can cause severe fatigue to the point that even the simplest daily activities can barely be performed.

Symptoms:

►     Fatigue – sleepiness

►     Exhaustion – tiring quickly

►     Dizziness and lightheadedness

►     Pale skin and mucous membranes (lips, gums, and conjunctivae), nails, and palms

►     Rapid heartbeat – tachycardia

►     Feeling cold, especially in the extremities

►     Depression

►     Low sex drive

►     Sleep disorder

►     Decreased appetite

Diagnosis

Physicians diagnose anemia through a conversation with the patient about his/hers symptoms (medical history/anamnesis), patient’s examination, and through blood tests. Blood tests nowadays are performed by modern automated analyzers that provide information on the number of erythrocytes (RBC), leukocytes (WBC) – with a differential image of individual fractions of leukocytes, additionally, the number of platelets (PLT), the level of hemoglobin, (Hb), and hematocrit (Hct).

RBC (red blood cells) – is the number of erythrocytes in the blood. Hemoglobin marked with acronym Hb, is found in the erythrocytes and it participates in the transfer of oxygen in the body. Your level of hemoglobin is actually the specified amount of this protein in your blood. Hematocrit or Hct, is the percentage of the red blood cells in the bloodstream. Anemia is diagnosed when the level of Hb and Hct falls below normal values, which results in disruption of the normal function of the organs and the body’s systems, manifested through the abovementioned symptoms.

Treatment

If anemia is left untreated, the condition can become serious. Aside from that, the low levels of erythrocytes can lead to additional health problems, such as: anemia could lead to work overload of the heart and consequently heart problems, caused by overcompensation for the low level of oxygen in the tissues. Moreover, anemia can impede the mental processes. When the brain does not receive a sufficient amount of oxygen, difficulties in learning, memorizing, and later on in writing, reading and performing the everyday tasks could arise. In case anemia is long lasting or its symptoms are worsening, it could seriously endanger your health.

The approaches of anemia treatment are different and they depend on the causes of the anemia. Therefore, after you have been diagnosed with anemia, the most important thing is to determine its cause. That is possible with the expert help of a medical specialist, who will determine the cause of the anemia and will decide on a treatment, such as changing dietary habits or prescribing the right medication. It is not recommended to threat anemia on your own, i.e. without a doctor’s supervision.

Manufacturer Siemens Healthcare Diagnostics

Why is prenatal screening performed?

Prenatal screening enables all pregnant women of any age and without any risk or pain, to find out more about the health of their unborn baby. The prenatal screening consists of a simple vein blood draw and a routine ultrasound examination at the gynecologist. Prenatal screening tests are a group of tests that give information to the doctor about the condition of the pregnant woman and her baby. These tests are quick, simple and highly specific with very high percentage of accuracy. It helps in identifying those pregnant women, out of the general population, who have an increased risk of delivering baby with defects.

What does PRISCA stand for?

PRISCA software (Prenatal RISk CAlculation software) includes measuring of specific markers that circulate in the blood of the mother and are directly related to the development and well-being of the fetus. The obtained values are combined along with other important parameters, such as: the age and health of the patient, as well as parameters of the fetus obtained by ultrasound (gynecological ultrasonography). Of no less importance is any other information gathered from the patient’s medical history, pregnancy, body weight, twin pregnancy, diabetes, and so on. After the software program calculates all the data, we get the final result, which indicates the risk of the fetus having one of the following abnormalities: Down syndrome, Edwards syndrome, and neural tube defect.

Down syndrome (trisomy 21) is a condition in which the fetus has excess genetic material, i.e. one more copy of the chromosome No. 21.This is the most common cause of mental retardation and it represents the most common chromosomal abnormality, which occurs with a frequency of 1 in 700-800 births. Although this syndrome is more common in women over 35 years of age, most babies with Down syndrome are born to mothers under 35 years. Infants with this disorder have a different physical appearance – broad face with slanted eyes, small ears with hearing impairment, short stature, mental retardation and often congenital heart defects, deformities of the gastrointestinal tract, etc.

Remember: positive screening test is not a final diagnosis; it just means that further more invasive tests are needed in order to determine whether your baby has any of the following conditions.

Which stage of pregnancy is best for conducting these tests for early detection of possible fetus defects?

The assessment of possible risks can be done very early, in the 10th to13th gestational week of the pregnancy. However, PRISCA can be performed up to the 22th week of the pregnancy.

What is the accuracy of the diagnostic procedures for detecting fetal abnormalities?

The percentage of detection of high-risk pregnancies, using this combination of laboratory marker-tests and ultrasound measures is up to 95%. However, a definitive confirmation is obtained only by invasive diagnostic procedures (amniocentesis or chorionic biopsy)

Is there a risk of causing unwanted abortion during the procedure?

Due to the fact that the entire procedure is safe, simple and inexpensive, prenatal screenings arerecommended for every pregnant woman*

(* Recommended by the American College of Obstetricians and Gynecologists, ACOG Practice Bulletin No. 77: Screening for Fetal Chromosomal Abnormalities. Obstetrics & Gynecology 2007; 109(1):217-228)