cardio labs Flashcards

Question

vasculitis

Answer 1

Definition: inflammation of the blood vessel wall -decrease blood flow -> necrosis of tissue - associated with autoimmune rxns: antineutrophil cytoplasmic antibody, elevated ANA - MC presentation = skin changes and modeled lacy skin pattern - different forms of vasculitis are classified by the size of the vessels affected Primary: no underlying ethiology Secondary: - due to infection (HIV, Hep B, Hep C, - due to autoimmune (lupus, RA):

Answer 2

Dx: - Presence of characteristics of particular clinical findings -Inflammation within particular size blood vessels - vessel bx + labs help dx Labs: -ANCA antibodies IgG (dont need to know this): systemic vasculitis -Elevated erythrocyte sedimentation rate (ESR) -C-reactive protein -End organ damage -antineutrophil cytoplasmic antibody, ANA

Answer 3

-mottled, lacey, palpable purpura -livedo reticularis -fever, headache, wt loss -joint pain -GI- bloody stool, ab pain -heart- MI, HTN -stroke- if pt comes in with suspected stroke -> and the c-reactive protein, ANA, ESR -> suspect vasculitis -eye- reduced visual acuity -nose bleeds -lungs- bloody cough, infiltrates -kidneys- glomerular nephritis

Answer 4

DVT: blood clots in veins in legs and can lead to PE in arteries D-Dimer: -Cross linked fibrin generation -Elevated in setting of DVT/PE however not specific! -Can help to rule out only: negative results = NO PE -is there a hypercoagulable state?

Answer 5

Work-up: -No diagnostic lab for stoke, no organ marker -Hypercoagulable work up: check PT/INR, PTT** -initiate anti-platelet therapy Ischemic stroke: blood supply cut off - MC - caused by atherosclerosis, Antiphospholipid syndrome (prothrombotic condition), thrombus, TIA, emboli Hemorrhagic: lack of blood flow due to hemorrhage - HTN: weakens arteries over time - AV malformations - Brain aneurysms

Answer 6

Ischemic chest pain pattern- STEMI, NSTEMI, unstable angina 1) manage them assuming ACS: do a EKG within 10 minutes, get troponin levels, BMP, chest xray 2) check troponin levels - yes = tx; no = move to next step 3) calculate the HEART pathway risk score: - Score: 0 = noncardiac chest pain - score 1+: need to obtain 2ND TROPONIN 3H after 1st one -> yes = tx; no = move to next step 4) recalculate HEART risk score - 0-3: evaluate other causes of chest pain - 3+: need to obtain a non-invasive eval prior to discharge

Answer 7

pt comes in with pattern of MI chest pain 1) manage them assuming ACS: do a EKG within 10 minutes, get troponin levels, BMP, chest xray

Answer 8

The TIMI Risk Score for UA/NSTEMI estimates mortality for patients with unstable angina and non-ST elevation myocardial infarction (MI).

Answer 9

SCORE: - tells you the risk of major adverse cardiovascular events for chest pain pts in the ED Values: -0-3- low risk -4-6- intermediate ->7- high risk

Answer 10

Cardiac troponin* -serial rise in troponin -elevation for days after MI - acute rise and fall pattern* -all other biomarkers of nonspecific and not helpful DDx: high troponin due to non-MI/ACS - will have ambiguous pattern of troponin change

Answer 11

-Only marker used to diagnosis a Myocardial Infarction! -Normal value is <0.01 ng/ml: + troponin = above the threshold -rises within 2-4 hrs*, peaks 10-24 hrs, drops within 1-2 weeks -Can calculate size or evolving MI (higher troponin = higher area of infarction) -Used in conjunction with clinical signs -dont need to know numbers -cardiac troponin I and cardiac troponin T -high sensitivity troponin assays have cut off that is 99th precentile of cardiac disease-free reference population

Answer 12

-cardiac surgery -cocain- vasospasms -PE, stroke -hemorrhage DDx: high troponin due to non-MI/ACS - will have ambiguous pattern of troponin change

Answer 13

Poor Specificity because of wide tissue distribution: -Aspartate Aminotransaminase (AST) -Creatine phosphokinase (CK) -CK-MB* -Myoglobin -Total lactate dehydrogenase (LDH)

Answer 14

Creatine kinase (CK) and its myocardial isoenzyme (CK-MB) -> used to be MC serologic tests for dx of MI prior to troponin - idea: muscle damage: CK enzymes will be released into bloodstream but it may also present in skeletal muscle (non-specific) -not really used anymore -Many institutions no longer offer CK-MB testing -some use CK-MB for detection of early reinfarction, although not guideline recommended

Answer 15

why is it not used: -Elevations in total serum CK lack specificity for myocardial damage, which improves with measurement of the MB fraction -normal range of CK VARIES; a twofold or greater increase in the CK concentration is required for dx; issue with pts with low muscle mass Criterion can be problematic in older individuals with lower muscle mass: - may have low baseline serum total CK and, during MI, may have elevated serum CK-MB with values of total CK that rise but REMAIN WITHIN NORMAL RANGE

Answer 16

Rhabdomyolysis: hallmark = elevation in CK and other serum muscle enzymes (5x upper limit of normal) -causes: sustained exercise, compartment syndrome, crush injury CK levels: -Serum CK levels at presentation: range from approximately 1500 to over 100,000 international units/L -rise: within 2 to 12 hours following the onset of MUSCLE INJURY and reaches its maximum within 24 to 72 hours - Decline: 3-5 days after cessation of muscle injury Serum half-life: 1.5 days and declines at a relatively constant rate of about 40 to 50 percent of the previous day’s value - In patients whose CK does not decline as expected -> concern for continued muscle injury or the development of a compartment syndrome

Answer 17

Myoglobin =ubiquitous heme protein that is rapidly released from damaged tissue because of its small size - half-life in plasma: 9 minutes (early) -Due to its early appearance in the serum, myoglobin was postulated to be a useful adjunct to either troponin or creatine kinase MB (CK-MB) for the early diagnosis of myocardial infarction (MI) -With highly sensitive cardiac troponin (cTn) assays and the use of the 99th percentile or 10 percent coefficient of variation cut-off, cTn is elevated PRIOR to elevations in myoglobin summary: - used to use myoglobin for MI because it was an early biomarker - now: troponin shows up even faster and its not used anymore - MYOGLOBIN USE IS IN RHABDOMYOLYSIS

Answer 18

Commonly used in the past in combination with AST and CK-MB to diagnose an acute MI - LDH: enzyme found in all parts of the body -LDH consists of M (muscle) and H (heart) subunits that give rise to five isoenzyme - heart: LD1 and some LD2 - Red cells, kidney, stomach, and pancreas are other important sources of LD1 - LD5: skeletal muscle and liver. LD levels with MI: - rises to abnormal levels 10 hours after the onset of MI - peaks at 24 to 48 hours - remains elevated for six to eight days Troponin = more specific than LD and remain elevated for 5 to 10 days - current recommendations suggest that LD no longer has a role in the diagnosis of MI

Answer 19

-only cardiovascular disease with INCREASING incidence -leading cause of hospitalizations in pts 65yo and older -5 mil pts with CHF, 400,000 new cases each year -5 year mortality 10% mild CHF- 80% end stage disease Definition: ineffective pumping of heart leading to accumulation of fluid in the lungs

Answer 20

Brain natriuretic peptide, BNP and BT-proBNP -released due to myocardial stress or fluid overload -Filling pressure defect -BNP = chronically elevated with acute elevation in setting of volume overload in CHF patients -Ordering a BNP in patients with shortness of breath can reduce uncertainty of diagnosis -normal BNP: dx of CHF is highly unlikely -useful for long term monitoring in guiding therapy, monitoring course of disease and risk stratification

Answer 21

Normal Range: - 5–1,300 pg/mL. Levels above 400 pg/mL: - indicates HF in patients with SOB Levels below 100 pg/mL: - high negative predictive value for HF - HF is unlikely if BNP is below this level -Difference by age, sex, BMI -Elevated in renal failure -Equivalent to or better predictor than CXR and P/E -Correlates with NYHA Class -Patients in the highest 25% have greater mortality at 2 years then those in lowest 25% -Can not be used with Entresto

Answer 22

Age ranges for HF diagnosis -<50yrs: HF at 450 pg/mL -50-75 yrs: HF at 900 pg/mL ->75 yrs: HF at 1800 pg/mL -It has a longer half-life than BNP and is considered to have greater prognostic value regarding left ventricular function -Difference by age, sex, BMI -Elevated renal failure

Answer 23

DECKS IN CLIN LAB CLASS (8)

cardio labs Flashcards

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