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Clinical Medicine LAB - Professor Sample > Cardiology Labs > Flashcards

Cardiology Labs Flashcards

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1
Q

Myocardial Response

A

Loss of critical blood supply to the myocardium

Decreased ATP and increased lactate accumulation

Loss of contractility

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2
Q

Myoglobin indications?

A

Early evaluation of pts with suspected AMI

Also used for disease/injury of skeletal muscle

(< 90 mcg/L)

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3
Q

Myoglobin is an __ binding protein found in _______ and ________ muscle?

A

O2
cardiac
skeletal

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4
Q

Myoglobin is more sensitive than ___________ but it is not as specific.

A

phosphokinase isoenzymes (CPK)

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5
Q

Myoglobin can be found in _____ and can turn it ___.

A

urine
red

use a urine dip stick - its the myoglobin that is turning it positive

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6
Q

Decreased myoglobin levels ?

A

Polymyositis: pts have antimyoglobin ab

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7
Q

Increased myoglobin ?

A

1-3 hrs after MI - soon - elevation occurs first

Peaks 6-9 hours after muscle injury

Skeletal muscle inflammation/ischemia/trauma

Rhabdomyolysis - muscle wasting -
to much exercise

Prolonged seizure - skeletal muscle damage

cells in cardiac muscle or skeletall muscle lyse and release myoglobin

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8
Q

How much time until myoglobin peaks?

A

6-9 hrs after muscle `

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9
Q

Creatine Kinase (CK, CPK) normal Values males and females?

A

Male: 55-170 units/L
Female: 30-135 units/L

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10
Q

Creatine Kinase (CK, CPK) normal Values newborn?

A

68-580 units/L

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11
Q 
Creatine Kinase (CK, CPK)
Isoenzymes?
A

CK-MM: 100%
CK-MB: 0%
CK- BB: 0%

most of CK found in skeletal muscle

BB- brain
MM- muscle
MB - muscle brain - heart

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12
Q 
Creatine Kinase (CK, CPK)
indications?
A

Support the diagnosis of MI

Indicate neurologic damage

Indicates skeletal muscle disease

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13
Q

Hemorrhagic stroke patho?

A

Hemorrhage/blood leaks into brain tissue

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14
Q

Ischemic Stroke patho?

A

Clots stops blood supply to an area of the brain

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15
Q

CK levels rise when _____, _____, or ________ muscle is damaged?

A

brian
heart
skeletal

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16
Q

CK rises within _ hours?

A

6

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17
Q

CK peaks at __-__ hours?

A

18-24

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18
Q

CK normalized - days?

A

2-3

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19
Q

Interfering factors of CK?

A

IM injections

Strenuous exercise

Recent surgery

Large muscle mass - elevated
CK all the time

Drugs (ETOH, AC, ASA, Lasix,
Decadron, morphine)

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20
Q 
Creatine Kinase (CK, CPK)
increased when?
A

Any injury to heart, brain, or skeletal muscle

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21
Q

Increased CK-BB

A

Electroconvulsive therapy

Adenocarcinoma - they do not know why

Pulmonary infarction - small amount in lung tissue

Brain injury (CVA, hemorrhage, seizures, shock, brain cancer)

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22
Q

Increased CK- MB:

A

AMI/cardiac ischemia

Cardiac surgery/defibrillation

Myocarditis

Others: severe skeletal injury, lung injury, or renal failure

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23
Q

Increased CK- MM?

A 
Rhabdomyolysis
MD
Myositis
Skeletal trauma/surgery
IM injections
Myositis

skeletal muscle

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24
Q

Troponin T (cTnT) normal level?

A

<0.2 ng/mL

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25
Troponin I (cTnT) normal level?
< 0.03 ng/mL
26
Troponin are proteins that exist within ________ and _______ muscle that regulate the _______ dependent part of muscle contraction
skeletal & cardiac calcium
27
Which troponin binds to calcium?
Troponin C
28
What are the two troponin that are cardiac specific?
Troponin T & Troponin I Troponin is so specificc that nothing else can really elevate it besides a MI
29
Disadvantage with troponin?
Falsely elevated in dialysis or renal failure patients
30
Advantages with troponin?
Highly specific to myocardial cell injury Will be normal with non-cardiac muscle disease Elevated sooner than CK (within 3 hours) Remain elevated longer T: 10-14 days I: 7-10 days
31
How long does troponin T stay elevated for?
10-14 days
32
How long does troponin I stay elevated for?
7-10 days
33
Is troponin elevated sooner than CK?
Yes , troponin is elevated after 3 hours, CK takes 6 hours
34
Indications for troponin?
Unstable angina Detection of reperfusion after recanalization Estimation of MI size - troponin will be higher if more damage Detection of perioperative MI Evaluate severity of PE - b/c ischemia Evaluate severity of CHF - damage to the ventricles from continuous heart strain
35
When is troponin increased?
MI | Myocardial injury
36
LDH ( lactic dehydrogenase) normal levels?
Adult: 100-190 units/L
37
LDH isoenzyme 1?
herat, RBC
38
LDH 2?
heart lung, reticuloendothelial system
39
LDH 3?
lung
40
LDH 4?
kidney, pancreas, placenta
41
LDH 5?
skeletal muscle, liver
42
When do we see a flipped LDH?
when someone is having a HA, LDH 1 is more sensitive and rises above LDH 2 ( usually LDH 2 is grater than LDH 1)
43
A total LDH will include all the isoenzymes which will be ________ with a different process?
elevated
44
LDH explanation?
During MI cells lyse and spill LDH into the blood stream When LDH 1 rises above LDH 2 this indicates myocardial injury (“flipped LDH”) Appears within 12-24 hours
45
When does LDH start to appear?
12-24 hours
46
Indications for LDH?
``` Diagnosis of injury: Heart Liver RBCs Kidneys Skeletal muscle Lungs ```
47
What are some factors that interfere with LDH?
Hemolysis of blood Strenuous exercise Drugs: Increase: ETOH, ASA, narcotics, procainamide Decrease: ascorbic acid
48
Drugs that increase LDH?
ETOH, ASA, narcotics, procainamide
49
Drugs that decrease LDH?
ascorbic acid
50
When will we see increased levels of LDH?
MI (LDH1 over LDH2) Pulmonary disease (LDH 2 & 3) Hepatic disease (LDH 5) Skeletal muscle disease Intestinal ischemia (LDH 5) Neoplastic states - b/c the way they spread Pancreatitis (LDH 4)
51
Highly sensitive CRP normal levels with cardiac risk?
Cardiac Risk: Low: <1.0 mg/L Average: 1.0-3.0 mg/L High: >3.0 mg/L
52
Indications for hs-CRP?
Indicates inflammatory illness Bacterial infections used to look for maybe a smoldering infection - follow CRP during treatment and watch it tank if infection is going away - get a baseline
53
When do we see increased levels of hs-CRP?
Inflammatory reactions Collagen-vascular disease Tissue infarction or damage Bacterial infections Malignant disease Post-operative wound infections Risk of cardiovascular events
54
Interfering factors for hs-CRP?
Cigarette smoking (b/c body is responding to salt) Medication (estrogens and progesterones) HTN Metabolic syndrome/ increased BMI/DM Chronic inflammatory conditions
55
Decreased levels for hs-CRP?
Fibrates, niacins, statins ETOH consumption Endurance exercise Weight loss
56
CRP and cholesterol ratios?
High CRP but LOW LDL then still high chance of HA ( CRP trumps)
57
Is hs-CRP used in acute MI?
NO
58
Why is hs-CRP very non-specific?
elevated in anyone that has inflammation in the body C-reactive protein
59
Normal ESR (Erythrocyte Sedimentation Rate, Sed Rate) levels?
Male :< 15 | Female: <20
60
What does ESR measure?
measure the rate the RBC settle or sediment is it important b/c if we have inflammation we have increased proteins and the RBC stack up faster
61
Is ESR non specific?
Yes, like hs-CRP
62
ESR explanation?
The rate at which RBCs settle in saline solution or plasma over a specific time period Increase in protein (fibrinogen) content of plasma making them stack up on each other and increases weight causing them to fall faster
63
Indications to us ESR?
Acute/chronic infection Detect illnesses Collagen-vascular disease Advanced neoplasm Tissue necrosis/infarction
64
Interfering factors for ESR that cause it to decrease?
Specimen allowed to stand >3 hours Drugs (ASA, cortisone, quinine) Sickle Cell Anemia Spherocytosis
65
Interfering factors for ESR that cause it to increase?
Pregnancy - 2, 3 trimesters when uterus is more stretched Menstruation Increased proteins (Macroglobulinemia) - increased RBC content as well Drugs (theophylline, vitamin A, OCP)
66
True increased results for ESR?
Chronic renal failure Malignant disease Bacterial infections Inflammatory disease Necrotic diseases (MI) Disease with increased proteins ``` Severe anemias (lower RBC volumes) - Fe deficiency and Vit. B12 - because they have lower volumes cause lower hemoglobin content ```
67
what is AST?
Aspartate Aminotransferase
68
Normal AST levels?
0-35 units/L
69
where is ALT mostly found?
liver
70
AST is found in highly _________ tissue
metabolic you can test AST 4 days out and it will still be elevated if you has an MI
71
AST is related to MI and cardiac by?
Directly related to how many cells were affected by the injury >5x normal levels in MI - and especially when the ALT is not elevated
72
BNP means?
Brain Natriuretic Peptide misnomer - it is not in the brain - its a good marker for CHF cause it is an indicator of muscle wall stretch
73
Normal BNP levels?
Normal : <100 pg/mL
74
Critical BNP levels?
Critical value: >100 pg/mL
75
Explanation in BNP?
Dilates blood vessels Lowers BP Responds to volume overload Released in response to the stretch on the atria and ventricles Correlates well to left ventricular pressure early CHF we may not have dyspnea or edema cause the heart is compensating but we can still find an elevated BNP indicating a stretch of the right side of the heart but just has no effect yet case the heart is compensating Late CHF the heart can no longer compensate so we get edema, and dyspnea and also an elevated BNP
76
Interfering factors with BNP?
Higher in healthy women Higher in older patients Post-op cardiac surgery
77
When will we see an elevated BNP?
CHF MI Systemic HTN Heart transplant rejection
78
AMA means?
Antimyocardial Antibody
79
normal AMA is?
Negative
80
when is AMA used?
Used to detect an autoimmune source of myocardial injury by using indirect immunofluorescence (IFA)
81
When do we get increased AMA levels ?
RAC Rheumatic heart disease - own body attacking tissue After MI (Dresslers Syndrome) body can attack the damage cause by the MI- swelling and inflammation in pericardium it can also happen after surgery as well ( associated with infarction or trauma) Cardiomyopathy - not sure why - but ABS are attacking heart tissue

Clinical Medicine LAB - Professor Sample (36 decks)

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