Biomarcadores cardíacos nas síndromes coronárias agudas
Palavras-chave:
Síndromes coronárias agudas, Biomarcadores cardíacos, Marcadores de necrose miocárdica, Troponina, Mioglobina, Creatina fosfoquinaseResumo
A triagem de doentes com dor torácica é um desafi o difícil,
lançado diariamente aos médicos em Serviço de Urgência. A
admissão hospitalar de casos com baixa probabilidade de Síndrome Coronária Aguda pode tornar-se incomportável, financeira e
logisticamente; do outro lado desta delicada balança está o risco
de se dar alta a doentes com enfarte agudo do miocárdio.
Os biomarcadores cardíacos são, para além da clínica e do
electrocardiograma, o terceiro elemento fundamental para a
abordagem diagnóstica das síndromes coronárias agudas. A
avaliação clínica é frequentemente limitada por sintomas atípicos e, não raras vezes, o electrocardiograma inicial não permite
o diagnóstico. É nestes doentes com um quadro clínico pouco
claro que o doseamento dos biomarcadores cardíacos assume
particular importância. O conhecimento do padrão de subida
destas substâncias no sangue periférico, das técnicas usadas
para a sua medição, dos valores de referência e das suas
vantagens e desvantagens é fundamental para uma utilização
adequada em determinado contexto clínico. Para além da sua
utilidade no diagnóstico ou na exclusão de enfarte agudo do
miocárdio, os biomarcadores cardíacos fornecem informação
prognóstica (estratifi cação de risco) e são utilizados para orientação terapêutica.
Neste artigo é feita uma revisão dos biomarcadores cardíacos
actualmente disponíveis na prática clínica hospitalar
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