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Diagnosing Cardiac Biomarkers Flashcards

(85 cards)

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1
Q

What are the most common CARDIAC BIOMARKERS used for diagnosis of cardiac injuries?

A

Creatine kinase (CK-MB isoenzyme)
Troponins

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2
Q

Which cardiac biomarker is the GOLD STANDARD for myocardial damage?

A

Troponins

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3
Q

What is “MB” in CK-MB

A

Cardiac muscle fraction

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4
Q

How many hours after onset of chest pain rises in serum for CK-MB

A

4-9 hours

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5
Q

What hour does it PEAK and returns to BASELINE for CK-MB

A

Peaks = 24 hours
Baseline = after 48-72 ours (2-3days)

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6
Q

What’s the normal amount of Troponin I (cTnl) found in the body

A

Less than 0.04 ng/mL

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7
Q

How many hours does troponin I starts to rise after initial myocardial injury?

A

2-3 hours
(She says 6-8 hours after injury?)

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8
Q

How many hours does troponin I (cTnl) PEAK?

A

12-24 hours

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9
Q

How many days can troponin I (cTnl) stay elevated?

A

7-10 days (normal)

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10
Q

What level of troponin I would indicate PROBABLE HEART ATTACK / myocardial damage

A

Greater than 0.4 ng/mL

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11
Q

What is the normal amount of troponin T (cTnT) found in the body

A

0-0.04 ng/mL

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12
Q

How many hours does Troponin T (cTnT) starts to rise after initial myocardial injury?

A

2-3 hours

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13
Q

How many hours does Troponin T (cTnl) PEAK?

A

10-24 hours

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14
Q

How many days can Troponin T (cTnT) stay elevated?

A

10-14 days (normal)

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15
Q

When a cardiac event is suspected, how many hours are Troponins typically cycled for to monitor evolving MI?

A

24 hours - 3 sets taken 8 hours apart

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16
Q

What are the natriuretic peptides that are released in response to pressure or volume overload?

A

Atrial & brain Natriuretic peptide (ANP/BNP)

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17
Q

Where is ANP released by

A

Atria

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18
Q

Where is BNP released by

A

Left ventricle

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19
Q

What is the primary function of ANP/BNP

A

Regulate body fluid homeostasis
Lowers BP
Getting rid of sodium (DIURESIS)

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20
Q

Increased concentration of ANP/BNP which could lead to increase severity of __?

A

CHF
Congested heart failure

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21
Q

___ levels are one of the important diagnostic tool for monitoring heart failure stability

A

BNP

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22
Q

What is the American Heart Association (AHA) guidelines for healthy individual total cholesterol

A

Less than 200mg/dL

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23
Q

What is the OPTIMAL cholesterol levels for a healthy individual ?

A

Less than 150 mg/dL

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24
Q

What is the normal triglycerides (sugar and starches in diet) for a healthy individual

A

Less than 150 mg/dL

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25
What is the normal amount of HDL in men/women
Men: 40 mg/dL Women: 50 mg/dL
26
High levels of ___ are inversely related to CAD risk
HDL
27
How do you increase / elevate levels of HDL
Diet and exercise
28
What is LDL
Contributes to atherosclerotic plaque formation
29
What is the optimal LDL levels for a healthy individual
Less than 100 mg/dL
30
Ratio of ____ are more important risk factors of CV disease than absolute values **
HDL/LDL or HDL/total cholesterol
31
What is hemoglobin
Role of transport of O2
32
What happens if our hemoglobin is low
heart rate increases because tries to deliver O2 to the blood which would increase WORKLOAD on the heart
33
What are the normal hemoglobin levels in men/women
Men: 14-17.4 g/dL Women: 12-18 g/dL
34
What is hematocrit (Hct)
Proportion of RBCs to the other components
35
What are the normal percent levels of hematocrit in men/women
Women: 37% Men: 42%
36
What is considered critically low for hematocrit levels
Less than 15-20%
37
What is the role of WBC
Fighting infection
38
What does it mean when you have elevated or high WBC count?
Infection present in the body
39
What are the normal WBC levels
5-10 (x1000/mm3)
40
What are the role of platelets
Assist with clotting
41
What are the normal platelets levels
150,000-450,000
42
What is the goal of coagulation
Maintain homeostasis
43
What is the role of fibrin
Creates a mesh that stabilizes platelet plug making it a true blood clot that initiates healing
44
What are anticoagulants
Reduce excessive clot formation
45
What are antiplatelet agents
Decrease platelet activity and reduce clot formation
46
What are thrombolytics
Breakdown clots that have already formed
47
Which antithrombotic agents that are used to treat acute stroke/ heart attacks
Thrombolytic - streptokinase, tPA
48
___ and ___ are used to measure the time to form clot
Prothrombin time (PT) Partial thromboplastin time (PTT)
49
What is partial thromboplastin time (PTT) used for
Measurement for HEPARIN dosing
50
What is prothrombin time (PT) used for
Most accurate way to monitor WARFARIN (COUMADIN)
51
What 3 electrolytes are most commonly monitored
Sodium Potassium Carbon dioxide
52
What 2 electrolytes are impacted by diuresis
Sodium Potassium
53
What can hypokalemia (low potassium) lead to
Serious life threatening arrhythmias
54
What can hyperkalemia (high potassium) impact
Myocardial contractility
55
What would happen if blood urea nitrogen (BUN) levels are ELEVATED
Indicates heart failure and/or renal failure
56
What would happen if creatinine levels are elevated
Renal disease
57
What are normal glucose levels
80-110mg/dL
58
What is considered MILD hyperglycemia
120-130mg/dL (pre diabetic state)
59
What glucose level is considered DIABETES
Greater than 126mg/dL on 2 separate test
60
Should you exercise if a patient is hyperglycemic?
No
61
What is event monitor used for
Used to diagnose more infrequent rhythm disturbances
62
What is a holter monitor used for
24-72 hour electrocardiographic monitoring of a patient’s heart rhythm
63
What does a echocardiography do
Provides real time imaging of beating heart
64
What is a transthoracic echo? (TTE)
Transducer placed on outside of chest wall
65
What is a transesophageal (TEE)
Insertion of transducer into esophagus
66
What is a Doppler echo
Provides info about blood flow direction and velocity
67
What are the main takeaways for an echocardiography?
Size of ventricular cavity Functioning of valves Motion of ventricular walls Performance of left ventricle Wall thickening due to ischemia
68
When should you use a stress echocardiography
During and immediately after exercise as well as recovery
69
What type of patients are more likely to use a stress echocardiogram
Younger patients with lower likelihood or symptomatic to CAD Patients with valvular heart disease Dyspnea is the main complaint
70
What is a cardiac catheterization used to assess for
Aortic valve dysfunction Coronary perfusion Left and right heart pressure Ventricular ejection fraction
71
Why would we use a pharmacological stress test
For individuals unable to perform exercise on treadmill or bike
72
What is a pharmacological agent used for
Used to induce coronary artery vasodilation ior stimulate exercise response
73
What is submaximal testing used for what type of patients ***
Most healthy sedentary individuals
74
What is submaximal testing used to measure?**
Measures cardiorespiratory fitness Develop exercise plan Prognosticate
75
What type of patients are used for “symptoms limited” testing
Individuals with symptoms of: Angina Dyspnea Asymptomatic with risk factors
76
For symptoms limited testing, what can we screen/diagnose
CAD Medical clearance to being exercise training
77
What is the more accurate equation to predict HR max
Tanaka equation
78
How do you calculate HR max with the Tanaka equation
208-(0.7 x age)
79
Submaximal testing is often used post ___
Cardiac surgery or post acute MI
80
Which type of testing is limited by patients subject signs and/or symptoms ?
Symptoms limited testing
81
What are indications to terminate exercise
SBP drops despite increase in workload 250/115 ST elevation/depression
82
What are ABSOLUTE contraindications to exercise testing
Acute MI within 2 days Decompensated heart failure
83
What are the 2 most important parts about testing ?
That the test is reproducible and measureable
84
When taking VS, what indicates patient’s peak HR ?
Just prior or within 10-15 secs Can use to establish prescription for exercise
85
What is a healthy response to exercise for SBP and DBP
SBP increases linearly (10-12mmHg0 DBP stays about the same or drops HR after the 1st minute (greater than 12bpm) Progressive decline in SBP

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