Exam 2, CV testing, darrow Flashcards Preview

Year 2 CV > Exam 2, CV testing, darrow > Flashcards

Flashcards in Exam 2, CV testing, darrow Deck (50):
1

substernal chest pain is indicative of what undderlying process

MI or angina

2

when troponin I is highly elevated with depressed ST segments what is probabl Dx

non ST segment elevated MI

3

which LDH is indicative of heart and RBC damage

1 and 2

4

what LDH is indicative of muscle and liver damage

4 and 5

5

What is so valualv about CK MB

back to level by day 3 unlike troponin so if there is a reinfarction, can be detected that way

6

what are the 3 single chains that make up troponin

troponin C- Ca binding troponin I- binds actin to inhibit myosin interaction tropinin T- binds tropomyosin and helps contraction

7

what is criteria for Dx AMI with biomarkers

at least one value above 99th percentile, tropinins preferredl so increased or falling troponin with symptomatic EKG or echocardiographic evidence of MI

8

which lab test is best for supporting Dx of CV disease

cholesterol

9

what is hsCRP

highly senstiive CRP

10

when is hsCRP increased

released by hepatocytes under influence of cytokines IL1 IL6 and TNF-a, so under any type of cell stress

11

what is best level of hsCRP

<1 mg/dL

12

the liver releases what in response to IL 1 IL6 and TNF-alpha

fibrinogen, serum amyloid A, CRP, C3' and haptoglobin

13

what is myeloperoxidase

WBC enzyme that produces toxic oxygen radicals in a respiratory burst to kill bacteria

 

14

what can myelopweroxidase be a marker for

plaque vulnerability preceding ACS

15

What are elevated homocysteine levels associated with

vascular injury, ASHD, coagulation and venous thromboembolism

16

Where on gel electrophoresis do HDL and LDL show up

HDL right next to albumin

LDL is the beta wave near gamma (last one)

17

how do you calculate total LDL-C

total cholesterol - 1/5 triglycerides +HDL-C

18

how do you calculat enon HDL cholesterol

total cholesterol- HDL-C

19

What is LDL-P

core lipid surrounded by phospholipid measured by NMR spec

20

Why is chlamydophylia pneumoniae a marker for CV disease

stimulates plaque formation

21

why is fibrinogen a marker for CV disease

binds platelets and sticks RBCs together (sed rate)

22

why is uric acid a marker for CV disease

part of metabolic syndrome

can irritate blood vessel wall

23

What is the PLAQ test

lipoprotein Phospholipase A2

eleveated levels lead to increased MI and stroke

cleaves oxidized fatty acids from LDL-C

24

What is the best marker for severity of CHF

serum Na

25

What is BNP and its effects?

Brain naturetic peptide from cardiac ventricles,a ctivates GPCRs

inhibits RAAS, endothelin secretion and SAN

increases renal blood flow and Na excretion

26

What do we use BNP levels for

assessing severity in ACS, stable angina, mitral regurgitation and aortic stenosis

27

If patient has dyspnea and a BNP level above 400 what does that mean

possible CHF

28

what is NT proBNP used for

useful to suggest CHF in patients with dyspnea 

29

At age 70 and above, NT proBNP levels are more conclusive, what is criteria for CHF

<400 excludes CHF

>2000 suggest CHF when Dx unclear

30

serum Na <135 means what in CHF patient

more likely to fall and increase in reoccurance of CHF episodes

related to excess vasopressin (ADH)

31

What are the mechs of hyponatremia in HF

increased nonosmotic release of arginine vasopressin from low CO, decreased renal blood flow, baroreceptor stimulation

potent thirst stimulation from low CO and ANGII

diuretics

other drugs like NSAIDs

32

What type of hyponatremia do diuretics and NSAIDs cause

hypotonic euvolemic

33

what type of hyponatremia is caused by CHF

hypotonic hypervolemic

34

What cardiac marker is most useful in excluding CHF on DDx

NT pro BNP

35

What is APO B 48 role

transport chylomicron for degradation

36

patient has high cholesterol, normal triglyceride and tendinous clumps of cholesterol, which type  of hyperlipoproteinemia is most likely

IIa

37

What is the mech behind type IIa hyperlipoproteinemia

defective LDL-Reeceptor with LDL-C attacment (defective apo B ligand)

cause high LDL-C

38

what are common signs of type IIa hyperlipoprotenemia

corneal arcus, xanthelasma and tendinous xanthomata, premature CAD, aortic stenosis

39

What diseases fall under the type IIa hyperlipoprotenemia category

familial hypercholesterolemia (auto dom)

familial defective apo B

polygenic nonfamilial hypercholesterolemia

40

patient has high cholesterol and TGL but no xanthomas

what type of hyperlipoprotenemia is most likely

IIb

41

what occurs in type IIb hyperlipoprotenemia

increased hepatic secretion of VLDL with ApoB100 and conversion to LDL with ApoB100

42

what type hyperlipoprotenemia is the most common cause of lactescent plasma and primary hyperlipidemia

type IIb (familial combined)

43

When patient's cholesterol and TGL are both extremely elevated and about equal eachother what type hyperlipoprotenemia is most likely?

III dysbetalipoproteinemia

44

what mutation causes type 3 hyperlipoprotenemia

E2/E2 instaead of E3 E3

or hepatic lipase deficiency mimicks this because plays role in ineffective clearance IDL

45

What are CHD "equivalents"

DM, TIA, PAD, AAA, 10 year risk asses of CHD >20%

46

What are other major CHD risk factors that are not equivalents

FH, low HDL-C, age, BP, smoking

47

how does reynolds change hsCRP

increases amount

48

What is Tx for clinical atherosclerotic CV disease

high intensity Tx. atorvastatin 40-80 mg or rosuvastatin 20-40

49

What is Tx for diabetic patients without clinical ASCVD afed 4-75 with LDL-C 70-180 and 1- yr risk >7.5

high intensity

atorvastatin or rosuvastatin

50