(F) L2: Markers for Cardiac Damage and Function (Part 2) Flashcards by Kchianna Lauren Coronel

Other Cardiac Markers

A heme-containing protein (skeletal and cardiac) that binds with oxygen
Found exclusively in muscle but absent in the circulation
Its presence in the blood is indicative of muscle damage but not specific to the heart
An adjunct marker in the early diagnosis of MI
Is quickly released during muscle damage due to its low MW of 18kDa, serving as the earliest cardiac marker but is not specific

Myoglobin

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Other Cardiac Markers

Is cleared by renal filtration
Levels are related to muscle mass and activity
One of the protein markers to diffuse out of ischemic muscle cells
A screening test for angina and early MI detection
Is measured in the serum

Myoglobin

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Other Cardiac Markers

Elevation: 1-4 hours
Peak: 6-9 hours
Decline: 18-24 hours

Myoglobin

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Other Cardiac Markers

An enzyme present in skeletal but not in cardiac muscle (negative marker)
Released from damaged muscle at a fairly fixed ratio to myoglobin in cases of cardiac damage

Carbonic Anhydrase

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Other Cardiac Markers

If a patient suffering from chest pains produces a (+) result for carbonic anhydrase, what is the interpretation?

The pain MAY NOT be of cardiac origin

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Other Cardiac Markers

An enzyme that catalyzes the first step in glycogenolysis
Consists of isoenzymes from the liver, muscles, brain, myocardium, and other tissues

Glycogen Phosphorylase

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Other Cardiac Markers

This GP isoenzyme is released earlier than other markers under conditions of reversible ischemia

GP-BB (brain)

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Other Cardiac Markers

Is found in all muscles but abundant in the heart
More sensitive in the diagnosis of acute MI than TnT and myoglobin but is less specific
Has a low MW of 15kDa and is used for fatty acid metabolism and lipid homeostasis
An early marker of myocardial damage with same kinetics as myoglobin

Heart-type Fatty Acid-binding Protein (H-FABP)

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Other Cardiac Markers

The ratio of myocardial to HFABP is (lower/higher) in the heart

Lower

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Other Cardiac Markers

Elevation: 2-4 hours
Peak: 5-10 hours
Decline: 24-36 hours

Heart-type Fatty Acid-binding Protein (H-FABP)

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Other Cardiac Markers

Does not detect myocardial tissue damage as it is not released from damaged myocytes (a unique marker)
Alters the cobalt-binding of albumin by its N-terminus domain
A modification of this is caused by free radical formation within minutes of ischemia in the heart
Has a reduced affinity for metal ions
Detects ischemia prior to irreversible cell damage

Ischemia-modified Albumin (IMA)

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Other Cardiac Markers

The thick filament of the muscle contractile apparatus (heavy and light chains)
Not specific for cardiac injuries hence not routinely used as a marker

Myosin

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Other Cardiac Markers

Includes myeloperoxidase (MPO), CRP, myeloid-related protein (MRP-8/14), and pregnancy-associated plasma protein A (PAPP-A)
Are inferior to troponins in detecting acute MIs
Is able to predict all-cause mortality and provide independent prognostic information apart from clinical risk factors

Novel Markers of Plaque Instability

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TOF: Cardiac markers are always associated with AMIs

False (also caused by cardiac insults that relate to cardiac injury)

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This is a key feature of cardiomyopathies due to genetic issues and stress-related causes
It comes in the form of apoptosis and/or necrosis

Cell Death

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A pathological state in which the heart fails to adequately supply the metabolic needs of the body due to a decrease in pumping function
Not only does it come from cardiac overload but also from a complex interplay among genetic, inflammatory, and biological changes acting on cardiac myocytes, cardiac interstitium, or both

Heart Failure

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This is the most common cause of heart failure

Coronary Heart Disease (CHD)

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Types of Heart Failure

Indicated by pulmonary edema and decreased systemic blood supply

Left-Sided Heart Failure

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Types of Heart Failure

Indicated by generalized edema

Right-Sided Heart Failure

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Left or Right-sided Heart Failure?

Most common type
The heart loses some of its ability to pump out blood after reoxygenation
Caused by coronary artery disease

Left-Sided

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Left or Right-sided Heart Failure?

The heart loses some of its ability to move oxygen-depleted blood to the lungs to pick up new oxygen
Most often caused by the other kind of heart failure
Can also occur even if the other side is apparently normal

Right-Sided

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Left or Right-sided Heart Failure?

Symptoms:
1. Paroxysmal nocturnal dyspnea
2. Elevated pulmonary capillary wedge pressure
3. Pulmonary congestion with cough, cackles, wheezes, and blood-tinged sputum
4. Tachypnea
5. Restlessness
6. Tachycardia
7. Exertional dyspnea
8. Fatigue
9. Cyanosis

Left-Sided

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Left or Right-sided Heart Failure?

Symptoms:
- Fatigue
- Increased peripheral venous pressure
- Ascites
- Enlarged liver and spleen
- May be secondary to chronic pulmonary problems
- Distended jugular veins
- Anorexia
- Complaints of GI distress
- Weight gain
- Dependent edema

Right-Sided

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Lab Tests for Patients with Suspected Heart Failure

This can help determine if anemia or infection may be the cause of heart failure

CBC

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# Lab Tests for Patients with Suspected Heart Failure This detects electrolyte imbalance which can cause fluid retention, and it may play a role in the severity of heart failure

Serum Electrolyte Levels

# Lab Tests for Patients with Suspected Heart Failure This can determine if damage to the kidneys, due to hypoperfusion, may be occurring secondary to heart failure

BUN/Creatinine

# Lab Tests for Patients with Suspected Heart Failure Increased levels in both diabetic and non-diabetic patients put them as an increased risk for heart failure

Fasting Glucose

# Lab Tests for Patients with Suspected Heart Failure - Elevated enzymes may indicate if the liver is affected due to heart failure - It can occur secondary to the inefficiency with which the heart is able to move the venous circulation

Liver Function Tests (AST, ALT, and LD)

# Lab Tests for Patients with Suspected Heart Failure - These 2 analytes are elevated after being released in the heart secondary to the stretch induced by heart failure - Their levels correlate closely with the severity of heart failure and can be used to differentiate cardiac causes of shortness of breath from primary lung disease

BNP and NT-proBNP Levels | Note: NT-proBNP is the precursor to BNP ## Footnote B-type Natriuretic Peptide (BNP) and N-terminal pro-B-type Natriuretic Peptide (NT-proBNP)

# Lab Tests for Patients with Suspected Heart Failure This can detect ischemia, infarction, and arrhythmias as a cause for heart failure

12-lead ECG

# Lab Tests for Patients with Suspected Heart Failure - Recent studies have described a relationship between the amount of protein excreted in urine and cardiovascular risk - This relationship may be due to the common manifestation of vascular endothelial cell dysfunction

Urinalysis

# Lab Tests for Patients with Suspected Heart Failure This includes TC, LDL, HDL, and TAG determination which are measured to determine the risk for CHD

Lipid Profile

# Lab Tests for Patients with Suspected Heart Failure This should be measured as both hyperthyroidism and hypothyroidism can be a primary cause of heart failure or can contribute to its severity

Thyroid Hormone Function Tests (TSH Levels)

# Laboratory Markers for Heart Failure - Is released in response to stress such as an increased pressure and volume load - It consists of 17 amino acid ring structures with cystine bridges - The main purpose of these is to increase diuresis, stimulate vasodilation, and increase excretion of sodium - It distinguishes the cardiac and non-cardiac causes of dyspnea - Higher levels are associated with a worse prognosis

Natriuretic Peptides

# Laboratory Markers for Heart Failure Natriuretic Peptides consist of 17 amino acid ring structures with cystine bridges consisting of what 5 members?

1. ANP 2. BNP 3. CNP 4. DNP 5. Urodilatin

# Laboratory Markers for Heart Failure Natriuretic Peptides may be in the form of what? (2 answers)

1. B-type Natriuretic Peptide (BNP) 2. N-terminal pro-B-type Natriuretic Peptide (NT-proBNP)

# Laboratory Markers for Heart Failure - Is mainly produced in the cardiac ventricle - Derived from a 108-aa prohormone (pro-BNP) - It increases in response to peptide ventricular systolic and diastolic dysfunction - Is diagnostic of congestive heart failure

B-type Natriuretic Peptide (BNP)

# Laboratory Markers for Heart Failure BNP is cleaved by this into a C-terminal fragment, active BNP, and an inactive N-terminal fragment (N-BNP or NT-proBNP)

Furin

# Laboratory Markers for Heart Failure An increased level of BNP in people with this condition indicates an increased risk of recurrent events

Acute Coronary Syndrome

# Laboratory Markers for Heart Failure - Is released by myocardial cells in response to increased volume, increased pressure, and cardiac hypertrophy - Includes BNP and NT-proBNP - Is elevated in patients with ventricular dysfunction - It can predict morbidity and mortality in patients with heart failure

Pro-BNP

# Laboratory Markers for Heart Failure TOF: Higher levels of BNP or NT-proBNP are often associated with a worse prognosis

True

# Laboratory Markers for Heart Failure - There is a 2.6-fold increased risk of in-hospital mortality for heart failure patients with elevated levels of this analyte at the time of admission - Severe chronic heart failure was also associated with a lower ejection fraction and deteriorating clinical course

Troponins

# Laboratory Markers for Heart Failure In acute heart failure patients without acute coronary syndrome (ACS), elevations in (blank) occur more often than (blank) elevations even though increases in either were related to increased mortality

1. Troponin I 2. Troponin T

A decrease in coronary blood flow due to coronary artery obstruction by plaques, platelets, and thrombi

Coronary Heart Disease

General results of cardiac ischemia includes what 3 conditions?

1. AMI 2. Angina pectoris 3. CHD

# Laboratory or Non-Laboratory CHD Risk Factors - Cigarette smoking - Hypertension - Family history of premature CHD - Men > 45 years old and women > 55 years old - Obesity - DM - Sedentary lifestyle

Non-Laboratory Risk Factors

# Laboratory or Non-Laboratory CHD Risk Factors - Serum cholesterol - LDL and HDL - Hormones - Clotting factors - Drugs - Toxins - Antioxidants and oxidants - Markers of infection/inflammation

Laboratory Risk Factors

# Laboratory Risk Factors for CHD This is the earliest identified and most important risk factor

Serum Cholesterol

# Laboratory Risk Factors for CHD This fraction serves as a primary risk factor

LDL

# Laboratory Risk Factors for CHD This is a negative risk factor

HDL

# Laboratory Markers for CHD - Found in elevated levels during inflammation and infection - Used as an early warning test to patients at risk of CHD - An inflammatory marker to reflect the severity of CHD and may contribute to its pathogenesis - High levels indicate a high predisposition to develop CHD and stroke

C-Reactive Proteins (CRP)

Give the cardiovascular disease risk level for the given hs-CRP value: < 1mg/L

Low Risk

Give the cardiovascular disease risk level for the given hs-CRP value: 1-3 mg/L

Average Risk

Give the cardiovascular disease risk level for the given hs-CRP value: > 3mg/L

High Risk

# Laboratory Markers for CHD - There is ocurrence of atherosclerosis in patients with massive elevation of this analyte - Measured by chromatographic techniques - This can modify LDL which enhances its uptake by macrophages

Homocysteine (HCY)

# Laboratory Markers for CHD High levels of this marker may be caused by: - A defect in methionine synthase - An inborn error of metabolism - Deficiency of vitamin cofactors for the metabolism of Vitamin B12, folate, and B6 (pyridoxine)

Homocysteine (HCY)

# Homocysteine Total Plasma Homocysteine Values: 5 to 15 µmol/L

Normal

# Homocysteine Total Plasma Homocysteine Values: 16 to 30 µmol/L

Moderate (high risk for CHD)

# Homocysteine Total Plasma Homocysteine Values: 31 to 100 µmol/L

Intermediate

# Homocysteine Total Plasma Homocysteine Values: > 100 µmol/L

Severe (usually seen in CHD)

# Homocysteine For every 5 μmol/L (0.7 mg/L) increase in serum homocysteine concentration, the risk of ischemic heart disease increases by how many percent?

20-30%

# Homocysteine Decreasing plasma homocysteine by 3 μmol/L (0.4 mg/L) can reduce the risk of ischemic heart disease by how many percent?

16%

# Homocysteine Decreasing plasma homocysteine by 3 μmol/L (0.4 mg/L) can reduce the risk of deep vein thrombosis by how many percent?

25%

# Homocysteine Decreasing plasma homocysteine by 3 μmol/L (0.4 mg/L) can reduce the risk of stroke by how many percent?

24%

What are the 2 laboratory markers for heart failure?

1. Natriuretic Peptide 2. Troponins

What are the 2 laboratory markers for CHD?

1. CRP 2. Homocysteine

What are the 2 forms of Natriuretic Peptides?

1. BNP 2. Pro-BNP

# Cardiac Insults Picture What are the 3 kinds of cardiomyopathies?

1. Dilated 2. Hypertrophic 3. Stress-Related

# Cardiac Insults Picture Wall stress is secondary to what condition?

Pulmonary embolism

# Cardiac Insults Picture Myocardial Infarction is secondary to what condition?

Ischemia

# Cardiac Insults Picture Myocarditis is caused by what microorganism?

Virus

# Cardiac Insults Picture Sepsis-related myocardial depression is caused by what harmful substance?

Bacterial toxins

# Cardiac Insults Picture What are the 2 heart traumas?

1. Mechanical 2. Cardioversion

(F) L2: Markers for Cardiac Damage and Function (Part 2) Flashcards

(73 cards)