Cardiac Enzyme Studies

Cardiac enzyme studies measure the levels of the enzyme creatine phosphokinase (CPK,
CK) and the protein troponin (TnI, TnT) in the blood. Low levels of these enzymes and
proteins are normally found in your blood, but if your heart muscle is injured, such as from a
heart attack, the enzymes and proteins leak out of damaged heart muscle cells, and their
levels in the bloodstream rise.
Because some of these enzymes and proteins are also found in other body tissues, their
levels in the blood may rise when those other tissues are damaged. Cardiac enzyme studies
must always be compared with your symptoms, your physical examination findings, and
electrocardiogram (EKG, ECG) results.
Why It Is Done
Cardiac enzyme studies are done to:

• Determine whether you are having a heart attack or a

threatened heart attack (unstable angina) if you have chest
pain, shortness of breath, nausea, sweating, and abnormal
electrocardiography results.
• Check for injury to the heart after bypass surgery.
• Determine if a procedure, such as percutaneous coronary
intervention (PCI), or a medicine to dissolve the blockage
(thrombolytic medicine) has successfully restored blood flow
through a blocked coronary artery.

How To Prepare
No special preparation is required before having this test.
Many medicines may affect the results of this test. Be sure to tell your health professional
about all the nonprescription and prescription medicines you take.
Talk to your doctor about any concerns you have regarding the need for the test, its risks,
how it will be done, or what the results will indicate. To help you understand the importance of
this test, fill out the medical test information form (What is a PDF document?) .
How It Is Done
The health professional drawing your blood will:

• Wrap an elastic band around your upper arm to stop the flow
of blood. This makes the veins below the band larger so it is
easier to put a needle into the vein.
• Clean the needle site with alcohol.
• Put the needle into the vein. More than one needle stick may
be needed.
• Attach a tube to the needle to fill it with blood.
• Remove the band from your arm when enough blood is
collected.
• Put a gauze pad or cotton ball over the needle site as the
needle is removed.
• Put pressure on the site and then put on a bandage.

Cardiac enzyme studies are often repeated over several hours for comparison. Blood
samples for these cardiac enzyme tests are usually drawn every 8 to 12 hours for 1 to 2 days
after a suspected heart attack, to look for the rise and fall in the enzyme levels.
 Results
Cardiac enzyme studies measure the levels of the enzyme creatine phosphokinase (CPK,
CK) and the protein troponin (TnI, TnT) in the blood.
Test results are usually available within an hour.
Values and units for reporting the results of cardiac enzyme tests vary considerably from lab
to lab. The values listed below can be used as a general guide. Check with your lab or doctor
for specific values.

Troponin (TnI and TnT)

Normal: TnI : Less than 0.3 micrograms per liter (mcg/L)

TnT : Less than 0.1 mcg/L

Abnormal: Elevated troponin may be present when you have heart muscle injury.
Blood levels of troponin typically rise within 4 to 6 hours after a heart
attack, reach their highest levels within 10 to 24 hours, and fall to
normal levels within 10 days.

Total CPK (creatine phosphokinase)

Normal: Men: 55–170 international units per liter (IU/L)

Women: 30–135 IU/L

Abnormal: CPK levels generally rise within 4 to 8 hours after a heart attack, reach
their highest levels within 12 to 24 hours, then return to normal within 3
to 4 days.

CPK-MB

Normal: Less than 3.0 nanograms per milliliter (ng/mL) (0% of total CPK)

Abnormal: CPK-MB is found in large amounts in the heart muscle. A CPK-MB

greater than 3.0 ng/mL may be present when you have muscle damage
caused by a heart attack. Blood levels of CPK-MB typically rise within 2
to 6 hours after a heart attack, reach their highest levels within 12 to 24
hours, and fall to normal levels within 3 days.

An ongoing high level of CPK-MB levels after 3 days may mean that a
heart attack is progressing and more heart muscle is being damaged.