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Clinical skills Yr2 > Data interpretation: Cardiac biomarkers > Flashcards

Data interpretation: Cardiac biomarkers Flashcards

STEMI, NSTEMI, unstable angina, stable angina (42 cards)

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1
Q

How do you explain to a patient what cardiac biomarkers are?

A

Substance that is released into the bloodstream when the heart is damaged or stressed

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2
Q

What are the 3 important cardiac biomarkers?

A

Troponin (TnT and cTnI)

Creatinine-kinase MB

Natriuretic peptides: BNP and NT-proBNP

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3
Q

How do you explain to a patient what troponin is?

A

A substance that is found in heart muscle

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4
Q

How do you explain to a patient what a high serum troponin level indicates?

A

Troponin is found in heart muscle, so when it is released into bloodstream this suggests that the heart muscle has become damaged or is stressed

Heart muscle damage usually occurs due to a heart attack, so you have either had a STEMI or NSTEMI

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5
Q

What is the cutoff level for high serum troponin?

A

0-14 ng/L: Normal

14-30 ng/L: Moderate, but can’t rule out ACS

30ng/L or more: Positive for STEMI or NSTEMI (or just highly specific for heart muscle srress/damage)

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6
Q

How do you explain to a patient what creatinine kinase-MB is?

A

Creatinine kinase is found in muscles, but CK-MB is the type that is only found in heart muscle

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7
Q

How do you explain to a patient what a high serum CK-MB level indicates?

A

CK-MB is found in heart muscle, so when it is released into bloodstream this suggests that the heart muscle has become damaged or is stressed

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8
Q

What is the cutoff level for high serum CK-MB?

A

0-25 IU/L: Normal

Above 25 IU/L: Heart muscle damage

1000-5000 IU/L: Risk of rhabdomyolysis

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9
Q

How do you explain to a patient what natriuretic peptides are?

A

They are hormones that are produced by the heart and blood vessels, and released into bloodstream in response to pressure and volume overload

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10
Q

What are the 2 types of natriuretic peptides in the cardiac biomarker profile?

A

B-type NP (BNP): Active form

N terminal-pro B-type NP: Inactive form

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11
Q

What heart conditions is troponin more specific for?

A

Highly specific for myocardial death

STEMI

NSTEMI

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12
Q

What heart conditions is CK-MB more specific for?

A

Highly specific for myocardial injury, not as specific for death

STEMI or NSTEMI

Myocarditis

Pericarditis

Heart surgery

Pulmonary embolism

Rhabdomyolysis

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13
Q

What heart conditions is BNP and NT pro-BNP more specific for?

A

Highly specific for volume or pressure overload, not as specific for myocardial death or stress

Heart failure

Cardiomyopathy

ACS

New/uncontrolled arrhythmias

Valve disease

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14
Q

Describe the cardiac biomarker profile in a STEMI?

A

Elevated troponin

Elevated CK-MB

Elevated BNP and NT pro-BNP

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15
Q

Describe the cardiac biomarker profile in a NSTEMI?

A

Elevated troponin

Elevated CK-MB

Elevated BNP and NT pro-BNP

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16
Q

Describe the cardiac biomarker profile in unstable angina?

A

Normal troponin: No myocardial death

Normal CK-MB: No myocardial injury

Elevated BNP and NT-pro BNP: Myocardial stress

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17
Q

Describe the cardiac biomarker profile in stable angina?

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A

Normal troponin: No myocardial death

Normal CK-MB: No myocardial injury

Normal BNP and NT-pro BNP: Causes transient myocardial stress

18
Q

Describe the cardiac biomarker profile in heart failure?

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A

Normal/elevated troponin

Normal/elevated CK-MB

Very high BNP and NT pro-BNP

19
Q

Describe the cardiac biomarker profile in myocarditis?

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A

Elevated troponin

Elevated CK-MB

Slightly elevated BNP and NT pro-BNP

20
Q

Describe the cardiac biomarker profile in pericarditis?

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A

Elevated troponin

Slightly elevated CK-MB

Slightly elevated BNP and NT pro-BNP

21
Q

How would you explain to a patient what myocarditis is?

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A

The heart walls are mostly made of muscle. Myocarditis is inflammation of the heart wall muscle

22
Q

How would you explain to a patient what pericarditis is?

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A

The heart is surrounded by a protective sac called the pericardium. Pericarditis is inflammation of the protective sac

23
Q

How would you explain to a patient the causes of myocarditis or pericarditis? CARDIAC RIND

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A

C: Collagen vascular diseases and CTDs eg. SLE. GCA, takayasu, sarcoidosis
A: Aortic aneurysm
R: Radiation
D: Drugs
I: Infections (usually viral, less commonly bacterial, mycotic, parasitic)
A: Acute renal failure
C: Cardiac infarction
R: Rheumatic fever
I: Injury and hypersensitivity reactions
N: Neoplasms
D: Dressler’s syndrome

24
Q

How do you explain to a patient the pathophysiology of myocarditis?

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A

A trigger, usually a viral infection, damages heart muscle cells.

This activates the immune response to fight off the trigger, which causes inflammatory cells to accumulate in the heart muscle

In acute myocarditis, the immune response works quickly and the inflammation goes down

In chronic myocarditis, the trigger and immune response create a cycle. This can eventually lead to scar tissue in the heart, which causes it to change shape which can cause dilated cardiomyopathy

25
How do you explain to a patient the pathophysiology of pericarditis?
A trigger, usually a viral infection, damages the pericardium This activates the immune response to fight off the trigger, which causes inflammatory cells to accumulate in the pericardial sac. Fluid builds up in the sac, this is called a pericardial effusion In acute pericarditis, the immune response works quickly and the fluid and inflammmation goes down In severe/chronic pericarditis, scar tissue in the pericardium forms rigid shell around heart and compresses it: This is called constrictive pericarditis
26
How do you explain to a patient the common symptoms of pericarditis?
Sharp stabbing pain between shoulder blades or on left side of chest, that is worse on breathing in or coughing and better when sat up Sick symptoms: Fever, nausea, breathlessness, lightheaded CONSTRICTIVE PERICARDITIS: Blood is struggling to enter heart, so will build up in systemic circulation --- Ascites, ankle swelling, hepatosplenomegaly, distended neck veins
27
How do you explain to a patient the common symptoms of myocarditis?
Pressure, tightness or squeezing pain in the chest that is worse on inspiration or coughing Sweating, SOB, palpitations, fluttering sensation, fatigue (due to arrhythmias from damaged heart chambers) Sick symptoms: Fever, nausea, breathlessness, lightheaded
28
How do you explain to a patient the investigations to diagnose pericarditis?
ECG: Saddle-shaped diffuse ST elevation with no reciprocal ST depression FBC, blood culture, CRP and ESR levels: Local infection U&Es, LFTs: Systemic origins of infection Cardiac biomarkers: Severity of heart stress CXR: Cardiomegaly in 'water-bottle' shape shows pericardial effusion TTE: Amount of thickening of pericardium, if it is compressing heart Specialist imaging: Cardiac CT or MRI
29
How do you explain to a patient the investigations to diagnose myocarditis?
ECG: Sinus tachycardia with diffuse ST elevation with no reciprocal changes FBC, blood culture, CRP and ESR levels: Local infection U&Es, LFTs: Systemic origins of infection Cardiac biomarkers: Severity of heart stress CXR: Cardiomegaly TTE: Thickened myocardium, weak contractions, reduced ventricular function Specialist imaging: Cardiac CT or MRI, cardiac catheter for myocardium biopsy
30
How do you explain to a patient which drugs are given to treat pericarditis?
1st line: NSAIDs/aspirin: These are drugs that reduce inflammation 2nd line: Colchicine: This is a drug that can stop the immune response from over activating in acute and recurrent pericarditis 3rd line: Low-dose prednisolone
31
How do you explain to a patient what NSAIDs are?
Non-steroidal anti-inflammatory drugs Blocks the enzyme cyclooxygenase (COX) from working, which is crucial in the production of prostaglandins. Prostaglandins cause fever, inflammation and pain. NSAIDs therefore reduce symptoms of pericarditis eg. Ibuprofen, naproxen, diclofenac
32
How do you explain to a patient the symptoms of NSAIDs?
GI issues: Stomach pain, heartburn nausea Headaches Dizziness Ringing in ears
33
If you prescribe an NSAID or aspirin, what else must you also prescribe and why?
PPI eg. lanzoprazole for gastroprotection NSAIDs and aspirin increase risk of peptic ulcer formation and GI bleeds, which can be dangerous
34
How do you explain to a patient what colchicine is?
A drug that acts against the inflammatory response, so prevents overactivation
35
How do you explain to a patient the side effects of colchicine?
Diarrhoea, nausea and vomiting, stomach pain Muscle weakness Sore throat -------------------------------------------------- If patient has GI problems, then also prescribe PPI
36
How do you explain to a patient what prednisolone is?
A corticosteroid drug A corticosteroid inhibits production of the substances that cause inflammation, therefore blocking the immune response from occurring
37
What surgical interventions can be used to treat pericarditis?
Pericardiocentesis: Needle into the pericardial sac to drain excess fluid that may be compressing the heart Pericardiectomy: In cases of constrictive pericarditis (where the pericardium becomes thickened and restricts heart function), surgical removal of the pericardium
38
How do you explain to a patient which drugs are given to treat myocarditis?
Treat underlying cause with antibiotics, antivirals, immunosuppressants and corticosteroids, stop drug if drug-induced 2. Chest pain treatment: NSAIDs/aspirin, colchicine, PPI 3. Heart failure treatment 4. Arrhythmia treatment
39
What surgical interventions can be used to treat myocarditis?
Mechanical circulatory support devices eg. VAD, ECMO, intra-aortic balloon pump Heart replacement
40
If patient has myocarditis, what must you warn the patient not to do?
Absolute rest during the acute phase Avoid competitive sports for at least 3–6 months (to prevent arrhythmias/sudden death)
41
How do you explain to a patient when to take NSAIDs?
Swallow tablet whole with water Take with or just after a meal, to reduce stomach side effects Take your forgotten dose as soon as you remember, unless it's nearly time for your next dose. In this case, skip the missed dose and take your next dose at the usual time (never take 2 doses at the same time)
42
How do you explain to a patient when to take colchicine?
Swallow tablet whole with water Take your forgotten dose as soon as you remember, unless it's nearly time for your next dose. In this case, skip the missed dose and take your next dose at the usual time (never take 2 doses at the same time) Take with or just after a meal, to reduce stomach side effects

Clinical skills Yr2 (38 decks)

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