Myoglobin holds oxygen inside heart and skeletal muscle (muscles that attach to and move bones). It is continually released into the blood in small amounts due to normal turnover of muscle cells. Kidneys discard the myoglobin into urine.
When muscle is damaged, as in a heart attack, larger amounts of myoglobin are released and blood levels rise rapidly. Myoglobin is one of the first tests done to determine if a person with chest pain is having a heart attack, as it may be one of the first blood tests to become abnormal.
Damage or injury to skeletal muscle also causes myoglobin to be released into the blood.
Heart attack must be diagnosed quickly. Medications to prevent heart damage are effective only within a limited number of hours. Yet, because of their risk for excessive bleeding, these medications are given only after a diagnosis of heart attack is made.
Myoglobin is one of several cardiac markers used to make the diagnosis. Cardiac markers are substances in blood whose levels rise in the hours following a heart attack. Increased levels help diagnose a heart attack; persistent normal levels rule it out.
Each cardiac marker rises, peaks, and returns to a normal level according to its own timeline, or diagnostic window. Myoglobin is useful because it has the earliest diagnostic window. It is the first marker to rise after chest pain begins. Myoglobin levels rise within two to three hours, and sometimes as early as 30 minutes. They peak after six to nine hours. The levels return to normal within 24-36 hours.
Although a rise in myoglobin supports a diagnosis of heart attack, it is not conclusive. Simultaneous skeletal muscle damage could also cause the increase. Myoglobin rules out, rather than proves, a diagnosis in the following way. If myoglobin levels have not risen after more than five hours, a heart attack is unlikely. Normal levels in the first two to three hours do not rule out an infarction.
The myoglobin test is sometimes repeated every one to two hours to watch for the rise and peak. Results are available within 30 minutes.
Myoglobin in large amounts is toxic to the kidney. When a person has high amounts of myoglobin in the blood, kidney function must be monitored.
This test requires 5 ml of blood. Collection of the sample takes only a few minutes. A urine myoglobin test requires 1 ml of urine collected into a urine collection cup.
Discomfort or bruising may occur at the puncture site or the person may feel dizzy or faint. Pressure to the puncture site until the bleeding stops reduces bruising. Warm packs to the puncture site relieve discomfort.
Normal results vary based on the laboratory and method used.
Myoglobin levels and levels of other cardiac markers are usually considered before finally confirming a diagnosis of heart attack. A level that has doubled after one to two hours, even if the level is still in the normal range, indicates a significant rise that may be due to heart attack.
Increased levels are also found with skeletal muscle damage or disease, such as an injury, muscular dystrophy, or polymyositis. Myoglobin levels also rise during renal failure because kidneys lose their ability to clear myoglobin from blood.
Wu, Alan, ed. Cardiac Markers. Washington, DC: American Association of Clinical Chemistry (AACC) Press, 1998.
Chesebro, Marcia J. "Using Serum Markers in the Early Diagnosis of Myocardial Infarction." American Family Physician (June 1997): 2667-2674.
Keffer, Joseph. "Myocardial Markers of Injury. Evolution and Insights." American Journal of Clinical Pathology (Mar.1996): 305-320.
Mercer, Donald W. "Role of Cardiac Markers in Evaluation of Suspected Heart attack. Selecting the Most Clinically Useful Indicators." Postgraduate Medicine (Nov. 1997): 113-117, 121-122.
Nancy J. Nordenson
Cardiac marker—A substance in the blood that rises following a heart attack.
Diagnostic window—A cardiac marker's timeline for rising, peaking, and returning to normal after a heart attack.
Myoglobin—A protein that holds oxygen in heart and skeletal muscle. It rises after damage to either of these muscle types.