- IM injections, strenuos exercise, early pregnancy, muscle mass

Cardiac biomarkers & lipids Flashcards by Maya Birchler

biomarkers for myocardial necrosis

creatine kinase, CK-MB, myoglobin, troponin

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biomarkers for myocardial ischemia

ischemia-modified albumin, heart-type fatty acid binding protein

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biomarkers for stress

aNP, proBNP, BNP

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biomarkers for inflammation and prognosis

CRP, sCD40L, homocysteine

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What are indications for CK, CPK, CK-MB?

diagnosis of myocardial muscle injury, neurological and skeletal muscle diseases

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First biomarker to rise in setting of MI is

Myoglobin

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CK levels rise within _ hours, peaks at __ and returns to baseline in

6 hours, peaks at 18, and returns to baseline in 2-3 days

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CK-BB

brain and lungs

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CK Mb

cardiac specific

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CK MM

skeletal muscles

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CK-MB rises in _ , peaks __, returns to normal in ___

4-6 hours, peaks 12-24 hours, returns to normal 48-72 hours

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What enzyme:
- helps differentiate reinfarction in setting of prior infarction
- used in surgery or trauma
- rise mildly in unstable angina and indicates increased risk for occlusive event

CK-MB

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What can affect CK?

IM injections, strenuos exercise, early pregnancy, muscle mass

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What can increase CK?

alcohol, amphotericin B. ampicillin, dexamethasone, furosemide, lithium, llidocaine, propranolol, succinylcholine

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Total CK can show

injury to heart, muscle, brain

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CK-BB can show

CNS, SAH, seizures, shock, reye syndrome, pulmonary infarction

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CK-MB can show

AMI, cardiac aneurysm surgery, cardiac defibrillation, myocarditis, ventricular arrhythmias, cardiac ischemia

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CK-MM can show

rhabdomyolysis, muscular dystrophy, myositis, IM injections, trauma, crush injuries, hypokalemia, hypothryoidism

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oxygen binding muscle protein released rapidly following skeletal/cardiac muscle

myoglobin

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earliest biomarker to rise after MI (2-3hours)

myoglobin

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Used to rule out acute MI in early hours of symptoms, instrumental in deciding whether to use thrombolytic

myoglobin – less specific than troponin, so can’t be used alone

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What interferes with myoglobin

IM injections
increase = AMI, myositis, malignant hyperthermia, muscle dystrophy, skeletal muscle ischemia, skeletal muscle trauma, rhabdomyolysis, seizures
decreased = polymyositis

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what to test when identify and stratifying patients w/ CHF

natriuretic peptides

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neuroendocrine peptides that oppose RAA system

natriuretic peptidesf

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found in cardiac atrial muscle, released as atrial stretch --> vaso-relaxation, inhibition of aldosterone secretion, natriuresis and reduction in BV occurs

ANP

found in membrane granules of cardiac ventricle, released as atrial stretch --> vasorelaxation, inhibition of aldosterone secretion from adrenal gland + renin from kidney, natriuresis + reduction occurs

BNP

found in nervous system but found to be produced by epitheleal cells

CNP

left ventricle releases this in response to increased wall tension and stretching, seen in heart failure

BNP

BNP > ___ = HF

400

elevated levels of this suggest HF, especially in acute decompensated HF high levels = worse prognosis elevated w/ SOB = cardiac risk stratification

BNP

NT-pro-BNP differentiates what

heart failure from other causes of dyspnea, but can vary

BNP is higher in

women older patients patients w/ recent post-cardiac surger CHF, MI, HTN, heart transplant rejection, cor pulmonale

gold standard for pulmonary HTN

troponin

found in cardiac muscle, highly specific + sensitive for MI.

troponin

Troponin rises within ___, peaks 12-24 hours, can stay elevated up to ___ weeks

3-6 hours,12-24 hours, can stay elevated up to 2 weeks

what can be used to determine cardiac ischemia, specific indicator for cardiac muscle injury and can elevate with PE, renal failure, sepsis?

troponin

____ are more specific for cardiac injury than CK-MB

troponins

CK-MB can also rise in

renal, cardiac, brain, skeletal muscle injuries

can troponins be used to determine reinfarction

what's used as a risk stratification tool in patients w/ CAD: elevated = increased risk of cardiac events such as ACS or stroke help assess inflammatory component >2 is considered high risk

CRP

what contains apoB-48, apoC-II, and apoE?

chylomicrons

apolipoprotein E is found in

chylomicron remnants, VLDL, HDL

VLDL is used for

transporting endogenous triclycerides

What do VLDLs contain

apoB-100 (present in VLDL and LDL, binds to LDL receptor to mediate LDL uptake), apoC-II and apoE

VLDLs are synthesized in the liver containing __

triglycerides and cholesterol

IDl is converted to

LDL

normal VLDL

7-32

normal troponin

T <.1 I <.04

normal BNP

<100

normal ANP

22-77

normal NT-pro-BNP

<300

normal myoglobin

<90

normal CK

male 38-174, female 26-140 MM 100% MB <5% BB 0%

Normal LDL is less than

<130

Normal HDL is

male >45, female >55

LDL contains

apoB-100

HDL contains

apoA-I (cholesterol efflux and reverse cholesterol transport) and apoC-II

75% of cholesterol is bound to

LDL

Normal TGs

<150

Increased or decreased cholesterol: -malabsorption -malnutrition -advanced cancer -hyperthyroidism -cholesterol-reducing meds -pernicious anemia -hemolytic anemia

decreased

increased or decreased TGs: - glycogen storgae disease - HLD - hypothyroidism - nephrotic syndrome

increased

lipid profile contains

total cholesterol LDL HDL TGs ratio non-HDL cholesterol (for risk)

General pop normal lipid panel:

<200 HDL >45 LDL <130 Non-HDL <130 VLDL 7-32 TGs <150

What's preferred LDL For CVD

<100, <70 mostly

What's preferred values for DM

LDL<70, HDL>50 for women

What's preferred values for DM and CVD

LDL<55

If someone has a very high HDL

consider alcoholism - can increase production of apolipoprotein A-I

If TGs >400, you will need to order a direct what?

HDL can be affected by

age, sex, post-MI, hypothyrodism (increases cholesterol), hyperthyroidism (decreases)

How can BBs affect your lipid panel?

increase TGs, decrease LDL size and HDL

How can alpha blockers affect your lipid panel?

decrease TGs, increase LDL and HDL

Dilantin can increase

HDL

Steroids and estrogens can increase

TGs

What can increase HDL?

alcohol, exercise, genetics

What can decrease HDL?

metabolic syndrome, familial low HDL, hepatocellular disease, hypoproteinemia

What can increase LDL and VLDL?

nephrotic syndrome, glycogen storage disease, hypothyroidism, ETOH, chronic liver disease, multiple myeloma, Cushing disease

What can decrease LDL and VLDL?

familial hypoproteinemia, hyperthyroidism

Statins will pull down all cholesterol levels including

HDL

Cardiac biomarkers & lipids Flashcards

(78 cards)