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CPK isoenzymes test

  • Definition
    • The CPK isoenzymes test measures the different forms of creatine phosphokinase (CPK) in the blood. CPK is an enzyme found mainly in the heart, brain, and skeletal muscle.

  • Alternative Names
    • Creatine phosphokinase - isoenzymes; Creatine kinase - isoenzymes; CK - isoenzymes

  • How the Test is Performed
    • A blood sample is needed. This may be taken from a vein. The test is called a venipuncture.

      If you are in the hospital, this test may be repeated over 2 or 3 days. A significant rise or fall in the total CPK or CPK isoenzymes can help your health care provider diagnosis certain conditions.

  • How to Prepare for the Test
    • No special preparation is needed in most cases.

      Tell your provider about all the medicines you are taking. Some drugs can interfere with test results. Drugs that can increase CPK measurements include the following:

      • Alcohol
      • Amphotericin B
      • Certain anesthetics
      • Cocaine
      • Fibrate drugs
      • Statins
      • Steroids, such as dexamethasone

      This list is not all-inclusive.

  • How the Test Will Feel
    • You may feel slight pain when the needle is inserted to draw blood. Some people feel or only a prick or stinging sensation. Afterward, there may be some throbbing.

  • Why the Test is Performed
    • This test is done if a CPK test shows that your total CPK level is elevated. CPK isoenzyme testing can help find the exact source of the damaged tissue.

      CPK is made of three slightly different substances:

      • CPK-1 (also called CPK-BB) is found mostly in the brain and lungs
      • CPK-2 (also called CPK-MB) is found mostly in the heart
      • CPK-3 (also called CPK-MM) is found mostly in skeletal muscle
  • What Abnormal Results Mean
    • Higher-than-normal CPK-1 levels:

      Because CPK-1 is found mostly in the brain and lungs, injury to either of these areas can increase CPK-1 levels. Increased CPK-1 levels may be due to:

      Higher-than-normal CPK-2 levels:

      CPK-2 levels rise 3 to 6 hours after a heart attack. If there is no further heart muscle damage, the level peaks at 12 to 24 hours and returns to normal 12 to 48 hours after tissue death.

      Increased CPK-2 levels may also be due to:

      • Electrical injuries
      • Heart defibrillation (purposeful shocking of the heart by medical personnel)
      • Heart injury (for instance, from a car accident)
      • Inflammation of the heart muscle usually due to a virus (myocarditis)
      • Open heart surgery

      Higher-than-normal CPK-3 levels are most often a sign of muscle injury or muscle stress. They may be due to:

      • Crush injuries
      • Muscle damage due to drugs or being immobile for a long time (rhabdomyolysis)
      • Muscular dystrophy
      • Myositis (skeletal muscle inflammation)
      • Receiving many intramuscular injections
      • Recent nerve and muscle function testing (electromyography)
      • Recent seizures
      • Recent surgery
      • Strenuous exercise
  • Considerations
    • Factors that can affect test results include cardiac catheterization, intramuscular injections, recent surgery, and vigorous and prolonged exercise or immobilization.

      Isoenzyme testing for specific conditions is about 90% accurate.

  • References
    • Anderson JL. ST segment elevation acute myocardial infarction and complications of myocardial infarction. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 73.

      Chinnery PF. Muscle diseases. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 429.

      Ferri FF. Muscular Dystrophy. In: Ferri FF, ed. Ferri's Clinical Advisor 2016. Philadelphia, PA: Elsevier Mosby; 2016:pp. 832-833.

      Nagaraju K, Lundberg IE. Inflammatory diseases of muscle and other myopathies. In: Firestein GS, Budd RC, Harris ED Jr, et al, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 85.