ACSM[042-082]

CHAPTER 3 Pre-Exercise Evaluations 55
TABLE 3.5. TIME-COURSE OF CHANGES IN SERUM CARDIAC
BIOMARKERS FOR MYOCARDIAL DAMAGE
MEAN TIME TO PEAK TIME TO RETURN
RANGE OF TIMES TO ELEVATIONS TO NORMAL
BIOMARKER INITIAL ELEVATION (NON-REPERFUSED) RANGE
CK-MB 3–12 h 24 h 48–72 h
cTnI 3–12 h 24 h 5–10 d
cTnT 3–12 h 12 h–2 d 5–14 d
CK-MB, MB isoenzyme of creatine kinase; cTnI, cardiac troponin I; cTnT, cardiac troponin T.
NOTE: Standard reference ranges are not available for the above cardiac biomarkers. The following are biochemical
indicators for detecting myocardial damage: (a) maximal concentration of cTnI or cTnT exceeding the decision limit
(ninety-ninth percentile of the values for a reference control group) on at least one occasion during the first 24 hours
after the index clinical event; (b) maximal value of CK-MB exceeding the ninety-ninth percentile of the values for a reference
control group on two successive samples, or maximal value exceeding twice the upper limit of normal for the specific
institution on one occasion during the first hours after the index clinical event. In the absence of availability of a
troponin or CK-MB assay, total CK (greater than two times the upper reference limit) or the B fraction of CK may be
employed, but these last two biomarkers are considerably less satisfactory than CK-MB.
Adapted from Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with
ST-elevation myocardial infarction. Circulation. 2004;110:588–636.
test or exercise program. The consent form should be verbally explained and
include a statement indicating that the patient has been given an opportunity to
ask questions about the procedure and has sufficient information to give
informed consent. Note specific questions from the participant on the form along
with the responses provided. The consent form must indicate that the participant
is free to withdraw from the procedure at any time. If the participant is a minor,
a legal guardian or parent must sign the consent form. It is advisable to check
with authoritative bodies (e.g., hospital risk management, institutional review
boards, facility legal counsel) to determine what is appropriate for an acceptable
informed-consent process. Also, all reasonable efforts must be made to protect
the privacy of the patient’s health information (e.g., medical history, test results)
as described in the Health Insurance Portability and Accountability Act (HIPAA)
of 1996. A sample consent form for exercise testing is provided in Figure 3.1. No
sample form should be adopted for a specific program unless approved by local
legal counsel.
When the exercise test is for purposes other than diagnosis or prescription
(i.e., for experimental purposes), this should be indicated during the consent
process and reflected on the Informed Consent Form, and applicable policies for
the testing of human subjects must be implemented. A copy of the Policy on
Human Subjects for Research is periodically published in ACSM’s journal, Medicine
and Science in Sports and Exercise.
Because most consent forms include a statement that emergency procedures
and equipment are available, the program must ensure that available personnel
are appropriately trained and authorized to carry out emergency procedures that
use such equipment. Written emergency policies and procedures should be in
place, and emergency drills should be practiced at least once every 3 months or