Cardiac enzymes

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Cardiac Enzymes Over Time

Type Interval (hours) Peak Elevation (hours) Return to Normal
Myoglobin 1-4 6-7 18-24 hours
Troponin I 3-12 10-24 3-10 days
Troponin T 3-12 10-24 5-14 days
CK-MB 4-12 12-24 2-3 days
LDH 8-12 24-48 10-14 days

Creatine Phosphokinase

  • Can be elevated in trauma, rhabdomyolysis, hyperthermia, physical activity, renal or endocrine disease, systemic infections
  • If patient small with small muscle mass to begin with, total ck may not be elevated- so better to use CK index- is ratio of CKMB/ total CK. Elevated if > 3- 5%.
  • CK Mass: with monoclonal antibody techniques, can directly measure ck mb mass as mmcg/L. More sensitive for detection of AMI
  • CK-MB can be removed from the routine ED cardiac panel without adversely affecting patient care[1]

See Also


  1. Le RD, Kosowsky JM, Landman AB, et al. Clinical and financial impact of removing creatine kinase-MB from the routine testing menu in the emergency setting. Am J Emerg Med. 2015;33(1):72–5.