Biomarkers for Cardiac Disease

Question 1

Risk Factors (RFs) for CHD (10)

Answer 1

-Age
-FMHx of CVD
-Male
-Unctrlled HTN & DM
-Incr. cholesterol (low HDL, high LDL, high triglycerides)
-Smoking, alcohol
-Sedimentary, poor diet
-Overweight/Obese (BMI = 25-30, 30-40, or >40)
-Postmenopausal
-Unctrlled stress

Question 2

LDL levels for incr. risk of CVD

Answer 2

> 50mg/dl

Question 3

What is cholesterol and what are the normal and abnormal levels of it in the blood?

Answer 3

-Waxy, fat-like substance thats a component of cell walls/fluidity and a precursor molecule for Vit D & sex steroids
Norm = <200 mg/dL
Borderline High = 200-239 mg/dL
High = > 240 mg/dL

Question 4

What is the carrier molecule that is required for effective transport of cholesterol in the blood? What are the different types?

Answer 4

-Lipoprotein
-Type based on density:
-HDL = High Density Lipoprotein
-LDL = Low Density Lipoprotein
-VLDL = Very Low Density Lipoprotein

Question 5

Lipid Panel Includes: (4)

Answer 5

1) Total cholesterol (HDL + LDL + Triglyceride)
2) LDL (Total - HDL - Trigly / 5)
3) HDL
4) Triglycerides

Question 6

Type of lipoprotein that’s inversely associated w/ Coronary Heart Disease.
Levels also increase with exercise.

Answer 6

HDL

Question 7

Lipoprotein that’s a causal RF for MI and atherosclerotic CVD.

Answer 7

LDL

Question 8

MOI of LDLs

Answer 8

LDLs invade tunica interna of vessels & form an atheroma (accumulation of materials in layer of artery wall). WBCs/macrophages move to area creating inflammatory rxn. Fibrous conn. tissues collects & swelling create an atherosclerotic plaque.

Question 9

Lipoprotein that’s estimated as a & of triglyceride value, but not a part of a lipid panel. High levels assoc. w/ plaque on artery walls.

Answer 9

VLDL

Question 10

What is Lipoprotein A & what are high levels assoc. w/?

Answer 10

-Lipoprotein subclass w/ an atherogenic & prothrombotic effect
-Atherosclerosis

Question 11

Lipoprotein A is a RF for:

Answer 11

CAD, CHD, CVA, thrombosis

Question 12

What is triglycerides & what are high levels assoc. w/?

Answer 12

-Glycerol molecule + 3 fatty acids
-Atherosclerosis, heart disease (HD), & CVA

Question 13

T/F: Cholesterol Ratio are clinically more important than Total cholesterol number.

Answer 13

False

Question 14

Cholesterol Ratio

Answer 14

-200/50 mg/dL = 4:1 ratio of Total cholesterol to HDL
-The lower, the better.
-Ratio should be kept to 5 or less.

Question 15

Types of triglycerides

Answer 15

saturated and unsaturated fats

Question 16

What is saturated fats and high levels assoc. w/?

Answer 16

-fat molecules w/ no double bonds b/c they are saturated w/ hydrogen molecules
-high levels assoc. w/ HD & CVA

Question 17

What is unsaturated fats and some types?

Answer 17

-Fat w/ =/>1 double bonds w/ a low melting point (room temp). Can be mono- or poly- unsaturated.
-Trans and Cis fatty acids

Question 18

What are Trans Fatty Acids and high levels assoc. w/?

Answer 18

-Produced in veggie oils/fats, uncommon in nature
-High levels assoc. w/ Coronary Vascular Disease

Question 19

T/F: Cis Fatty Acids are naturally occurring and good for your health.

Answer 19

True

Question 20

Triglyceride Levels

Answer 20

Norm = <150
Borderline High = 150-199
High = 200-499
Very High = >500

Question 21

Men and women at incr. risk of CHD should get cholesterol screening as early as what age?

Answer 21

20 y/o

Question 22

All men and women should get cholesterol screening at what ages? and How often?

Answer 22

Men > 35 y/o
Women > 45 y/o

Question 23

Children should have their cholesterol check b/w ages ______ and again b/w ages ___.

Answer 23

9-11 y/o
17-21 y/o

Question 24

Medications used to manage Lipid levels (3)

Answer 24

1) Statins
2) Niacin (Vit B3)
3) PCSK9 inhibitors (new drug class, reduce degradation of LDL, lowering LDL blood levels)

Question 25

Statin Induced Myelopathy and RFs for this

Answer 25

-Myalgias to muscle tenderness, to weakness to rhabdomyolysis (leads to kidney failure) -Usually resolve after stopping meds -RFs: high dose, incr. age, mult. diseases, frail, immunosuppressant drugs

Question 26

Pathophysiology of CVD & DM (Diabetic Heart Disease)

Answer 26

-Hyperglycemia creates a proinflammatory statre which incr. platelet activation (CVA/ischemia risk) & dyslipidemia tht drives arterial stiffness (atherogenesis)

Question 27

Structural abnormalities characteristic of a diabetic heart. (5)

Answer 27

-Fibrosis -Cardiac hypertrophy -Impaired Coronary Microvascular Perfusion -Mitochondria dysfunction -Impaired calcium handling

Question 28

"Cardiac Enzymes"

Answer 28

blood values of biomarkers that incr. w/ the occurrence of an MI

Question 29

Ischemic insult can lead to...

Answer 29

cell injury/death → sarcolemma disruption → movement of contents into IS & blood.

Question 30

What is Creatine Phosphokinase and its diff forms (3)?

Answer 30

-Catalyzes conversion of creatine & ATP to phosphocreatine (PCr) and ADP. PCr is an immediate energy source. -Forms: -**MB: most specific, Myocardial Band injury -MM: MSK damage -BB: for brain tissue injury

Question 31

CPK serum levels after MI or other injury/insult

Answer 31

Rise: 4-6 hrs Peak: 12-24 hrs Remain elevated: 4-5 days Norm levels:

Question 32

T/F: HBDH & LDH rise 6 hrs following MI, but AST & CPK levels elevate must later & remain high for a longer period.

Answer 32

False, its flip flopped

Question 33

Troponin & diff forms/types (3)

Answer 33

Group of proteins in striated muscle that bound to actin. Released/levels rise after cardiac muscle injury. -TnC = binds to Ca -TnI = inhibits actin/myosin interaction -TnT = links troponin to tropmyosin

Question 34

Normal Levels of Troponin and levels after MI

Answer 34

Norm =/< 3.0 Rise: 4-6 hrs (TnI) 3-4 hrs (TnT) Peak: 12-24 hrs (TnI) 10-24 hrs (TnT) Remains elevated: 4-7 days (TnI) 10-14 days (TnT)

Question 35

T/F: Myoglobin levels rise faster than Troponin and began to drop rapidly within a day after an MI.

Answer 35

True

Question 36

What is myoglobin and normal serum levels?

Answer 36

-Heme protein in all muscle tissue (stores O2). ***Potential dx tool for acute MI*** Norm = 25-72

Question 37

When can you detect myoglobin after an MI and what would blood levels look like?

Answer 37

-As early as 2 hours after injury -Peak: 3-15 hrs after injury

Question 38

Why is a liver panel of interest post-MI

Answer 38

CO dysfunction leads to reduced liver perfusion leading to congestion of blood in the liver & incr. component in liver panel

Question 39

Patients with HF have (elevated/depressed) serum levels of bilirubin.

Answer 39

Elevated

Question 40

What is ANP and what does it result in?

Answer 40

-Hormone secreted in response to atrial distention -Inr. GFR & limits RAAS activation -Results in vasodilation, diuresis, ↓ preload, ↓ afterload, ↓ heart workload

Question 41

What serum level is a marker for severity of HF?

Answer 41

ANP increases with increasing HF severity (inhibits cardiac hypertrophy & fibrosis)

Question 42

What is the gold standard for measurement of compensated & uncompensated HF?

Answer 42

BNP

Question 42

What is BNP and levels in pts with HF

Answer 42

-Produced in response to ventricular distention (incr. LVEDV caused by decr. GFR, cardiac muscles being stretched) -limits RAAS activation too -BNP increases with increasing HF severity too

Question 43

BNP Normal Levels and Levels in pts w/ HF

Answer 43

Norm = <100 Chronic cardiac compensation = 100-700 Acute cardiac decompensation = >700

Question 44

Classifications of Cardiac disease

Answer 44

1) disease but no S&S or limitations 2) mild S&S & slight limitations 3) marked limitation d/t S&S, only comfortable at rest 4) severe limitations w/ S&S at rest, bedbound

Question 45

What is C Reactive Protein (CRP) and what are norm levels

Answer 45

-Produced/secreted from liver in inflammatory states (atherosclerosis, CHF, cancer, infection, liver dysfunction) -Measure of inflammation levels in body Norm = <1 High risk = 1-3 Evaluated for non-CV diseases (autoimmune, cancer, infection) = >10

Question 46

T/F: Among postmenopausal women, whether CRP levels are high or low, if cholesterol ratio is high then risk of CV event increases.

Answer 46

true

Question 47

What is serum creatinine and norm levels/levels that predict CV mortality?

Answer 47

-Blood levels reflect kidney function (decr. function = decr. renal perfusion) Norm = <1.5 CV Mortality Predictor = incr. levels of serum creatinine