Creatine kinase - isoenzymes

Alternative names
Creatine phosphokinase - isoenzymes; CPK isoenzymes; CK - isoenzymes

This blood test measures the isoenzymes (different forms) of creatine phosphokinase.

How the test is performed

Blood is drawn from a vein, usually in the arm. The puncture site is cleaned with antiseptic, and a tourniquet (an elastic band or blood pressure cuff) is placed around the upper arm to apply pressure and cause veins below the tourniquet to fill with blood.

A needle is inserted into the vein, and the blood is collected in an airtight vial or a syringe. During the procedure, the tourniquet is removed to restore circulation and facilitate the collection of blood. Once the proper amount of blood has been drawn, the needle is removed, and the puncture site is covered to stop any bleeding.

Infant or young child:
The area is cleansed with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube), on a slide, onto a test strip, or into a small container. A piece of cotton or a bandage may be applied to the puncture site if there is any continued bleeding.

This test may be repeated over 2 or 3 days for hospitalized patients. A significant rise or fall in the total CPK or CPK isoenzymes can be very helpful to health care providers for the diagnosis of certain conditions.

How to prepare for the test

Usually, no special preparation is necessary.

Infants and children:
The physical and psychological preparation involved in readying a child for any test or procedure depends on the child’s age, interests, previous experiences, and level of trust. For specific information on how to prepare your child based on their age, see the following topics:

  • Infant test or procedure preparation (birth to 1 year)  
  • Toddler test or procedure preparation (1 to 3 years)  
  • Preschooler test or procedure preparation (3 to 6 years)  
  • Schoolage test or procedure preparation (6 to 12 years)  
  • Adolescent test or procedure preparation (12 to 18 years)

How the test will feel
When the needle is inserted to draw blood, some people may feel moderate pain, while others may feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the test is performed

CPK isoenzymes are performed when the total CPK level is elevated. Isoenzyme testing can help differentiate the source of the damaged tissue.

CPK is an enzyme found predominantly in the heart, brain, and skeletal muscle. CPK is composed of 3 isoenzymes that differ slightly in structure:

  • CPK-1 (also called CPK-BB) is concentrated 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

Because the CPK-1 isoenzyme is predominately found in the brain and lungs, injury to either of these organs (for example, stroke or lung injury due to a Pulmonary embolism) are associated with elevated levels of this isoenzyme.

CPK-2 levels rise 3 to 6 hours after a heart attack. If there is no further damage to the heart muscle, the level peaks at 12 to 24 hours and returns to normal 12 to 48 hours after tissue death. CPK-2 levels do not usually rise with chest pain caused by angina, Pulmonary embolism (blood clot in the lung), or congestive heart failure.

The CPK-3 isoenzyme is normally responsible for almost all CPK enzyme activity in healthy people. When this particular isoenzyme is elevated, it usually indicates injury or stress to skeletal muscle.

What abnormal results mean
Higher-than-normal CPK-1 levels may occur with the following:

  • Brain cancer  
  • Brain injury (due to trauma, stroke, or bleeding in the brain)  
  • Electroconvulsive therapy  
  • Pulmonary infarction  
  • Seizure

Higher-than-normal CPK-2 levels may occur with the following:

  • Heart attack       o There is a significant rise in CPK-2 levels in the first 2 to 3 hours after a heart attack. This test is used to diagnose a heart attack.       o         The extent of the elevation depends on the severity of the heart attack. CPK levels may remain elevated up to 24 hours after a heart attack, and sometimes even longer.  
  • Myocarditis (inflammation of the heart muscle usually due to a virus)  
  • Electrical injuries  
  • Trauma to the heart (for instance, from a car accident)  
  • Heart defibrillation (purposeful shocking of the heart by medical personnel)  
  • Open heart surgery

Higher-than-normal CPK-3 levels may occur with the following:

  • Crush injuries of skeletal muscle  
  • Multiple intramuscular injections  
  • Muscular dystrophy  
  • Myositis (skeletal muscle inflammation)  
  • Post-electromyography (a test of nerve and muscle function)  
  • Recent seizures  
  • Recent surgery  
  • Rhabdomyolysis (skeletal muscle damage due to drugs or prolonged immobilization)  
  • Strenuous exercise

Special considerations

Factors that can affect test results include cardiac catheterization, intramuscular injections, recent surgery, and vigorous and prolonged exercise or immobilization.

Drugs that can increase CPK measurements include the following:

  • Amphotericin B  
  • Ampicillin  
  • Some anesthetics  
  • Anticoagulants  
  • Aspirin  
  • Clofibrate  
  • Dexamethasone  
  • Furosemide  
  • Morphine  
  • Alcohol  
  • Cocaine

Isoenzyme testing for specific conditions is about 90% accurate.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.