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Clinical Science > Lecture 11: "I've got a polish sausage stuck in my coronary artery" > Flashcards

Lecture 11: "I've got a polish sausage stuck in my coronary artery" Flashcards

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1
Q

What is the function of natriuretic peptides?

A

function to inhibit the reabsorption of sodium in the renal tubule so that sodium excretion in urine is increased

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2
Q

What is the function of natriuretic peptides?

A

function to inhibit the reabsorption of sodium in the renal tubule so that sodium excretion in urine is increased

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3
Q

What are the three major natriuretic peptides?

A

ANP, BNP, and C-type (CNP)

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4
Q

What are some causes of CHF?

A

hypertension, coronary artery or valvular hear disease, diabetes mellitus, or congenital heart disease

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5
Q

What is the role of BNP in the heart?

A

along with ANP it is released when the atria and ventricles stretch -> they cause vasorelaxation and increase the amount of sodium and water excreted

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6
Q

What is the role of creatine kinase?

A

this enzyme metabolizes creatine found in the mitochondria and cytoplasm of skeletal muscles to phosphocreatine; ATP is generated from this process

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7
Q

What is the normal level for creatine kinase?

A

50-200 U/L

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8
Q

What does elevation of total CK typically represent?

A

injury to the skeletal muscle

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9
Q

What are the three isoenzymes of Creatine Kinase?

A

CK-MM, CK-BB, CK-MB

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10
Q

Why is a CK-MB test not preferred to diagnose MI?

A

lack of specificity, lack of sensitivity, late increase in disease process, high levels can indicate that extensive myocardial damage has already occurred

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11
Q

Which troponin subtypes are used to diagnose an MI?

A

Troponin I and Troponin T

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12
Q

What is the interaction between troponin and calcium skeletal and cardiac muscle?

A

when troponin is bound by calcium it allows for exposure of the myosin binding sites on actin; troponins interact with calcium ions and tropomyosin during muscle contraction

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13
Q

What is the normal value for cardiac troponin I?

A
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14
Q

Why is cardiac troponin I used more commonly than troponin T?

A

renal failure more frequently increases cardiac troponin T

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15
Q

What is the function of myoglobin?

A

occurs only in the skeletal or cardiac muscle tissue; serves as a short-term oxygen storage in muscle tissue

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16
Q

When is myoglobin known to increase?

A

3 hours after cardiac injury- is an early maker; only released into serum when there is a skeletal or cardiac muscle injury

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17
Q

What is the normal value for cardiac troponin T?

A
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18
Q

What is the preferred test to diagnose a patient with acute coronary syndrome or myocardial injury?

A

troponin

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19
Q

What is lactate dehydrogenase?

A

enzyme that catalyzes the conversion of lactate to pyruvate

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20
Q

What is lactate dehydrogenase involved in?

A

energy production of the cells

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21
Q

Where is lactate dehydrogenase found?

A

tissues of heart, liver, RBCs, kidneys, skeletal muscle, brain, and lungs; not very specific

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22
Q

When is LDH released?

A

released into the blood when injury occurs but it is not very specific for one disease

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23
Q

What isoenzymes of LDH is usually most abundant?

A

LDH-2

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24
Q

When is LDH-2 not the most abundant?

A

during a myocardial infarction and LDH-1 becomes most abundant; this is called a flipped LDH

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25
What is the normal value of D-Dimer?
26
What is D-Dimer typically used to diagnose?
a patient with a deep vein thrombosis (DVT) or pulmonary embolism (PE)
27
What is the normal value for a C-Reactive Protein- High Sensitivity (CRP-HS) test?
28
What is C-Reactive Protein
an acute phase reactant and an inflammatory mediator; produced in the liver in response to inflammation and infection
29
When is CRP-HS screening useful?
in assessing likelihood of future cardiac events
30
What does low-density lipoprotein carry?
75% of cholesterol
31
What does high-density lipoprotein carry?
25% of cholesterol; much more protein dense and therefore carries less cholesterol
32
What does a lipid panel generally include?
total cholesterol, triglyceride, HDL, and LDL
33
How often should diabetics have a lipid panel?
annually
34
If initial lipid panel test is normal how often should you test a patient?
test can be performed every 5 years
35
What should be your total cholesterol normal value?
36
What factors increase triglyceride levels?
familial hypertriglyceridemia, hyperlipidemia, hypothyroidism, high carb diet, poorly controlled diabetes, chronic renal failure
37
What factors decrease triglycerides?
malabsorption and malnutrition, hyperthyroidism
38
What factors increase HDL:?
exercise, moderate alcohol use, healthier eating choices, estrogen administration, familial HDL lipoproteinemia
39
What factors decrease HDL?
tobacco use, metabolic syndrome, genetically low HDL, hepatic disease
40
What are lab values for LDL that are ideal for those at risk of heart disease?
70-100 mg/dL
41
What is a high LDL lab value?
>160 mg/ dL
42
How does LDL particle sixe affect risk of CAD?
there is an increased risk of CAD with small, dense LDL particles; these small dense particles are more dangerous and promotes atherosclerosis and thrombosis
43
What are the three major natriuretic peptides?
ANP, BNP, and C-type (CNP)
44
What are some causes of CHF?
hypertension, coronary artery or valvular hear disease, diabetes mellitus, or congenital heart disease
45
What is the role of BNP in the heart?
along with ANP it is released when the atria and ventricles stretch -> they cause vasorelaxation and increase the amount of sodium and water excreted
46
What is the role of creatine kinase?
this enzyme metabolizes creatine found in the mitochondria and cytoplasm of skeletal muscles to phosphocreatine; ATP is generated from this process
47
What is the normal level for creatine kinase?
50-200 U/L
48
What does elevation of total CK typically represent?
injury to the skeletal muscle
49
What are the three isoenzymes of Creatine Kinase?
CK-MM, CK-BB, CK-MB
50
Why is a CK-MB test not preferred to diagnose MI?
lack of specificity, lack of sensitivity, late increase in disease process, high levels can indicate that extensive myocardial damage has already occurred
51
Which troponin subtypes are used to diagnose an MI?
Troponin I and Troponin T
52
What is the interaction between troponin and calcium skeletal and cardiac muscle?
when troponin is bound by calcium it allows for exposure of the myosin binding sites on actin; troponins interact with calcium ions and tropomyosin during muscle contraction
53
What is the normal value for cardiac troponin I?
54
Why is cardiac troponin I used more commonly than troponin T?
renal failure more frequently increases cardiac troponin T
55
What is the function of myoglobin?
occurs only in the skeletal or cardiac muscle tissue; serves as a short-term oxygen storage in muscle tissue
56
When is myoglobin known to increase?
3 hours after cardiac injury- is an early maker; only released into serum when there is a skeletal or cardiac muscle injury
57
What is the normal value for cardiac troponin T?
58
What is the preferred test to diagnose a patient with acute coronary syndrome or myocardial injury?
troponin
59
What is lactate dehydrogenase?
enzyme that catalyzes the conversion of lactate to pyruvate
60
What is lactate dehydrogenase involved in?
energy production of the cells
61
Where is lactate dehydrogenase found?
tissues of heart, liver, RBCs, kidneys, skeletal muscle, brain, and lungs; not very specific
62
When is LDH released?
released into the blood when injury occurs but it is not very specific for one disease
63
What isoenzymes of LDH is usually most abundant?
LDH-2
64
When is LDH-2 not the most abundant?
during a myocardial infarction and LDH-1 becomes most abundant; this is called a flipped LDH
65
What is the normal value of D-Dimer?
66
What is D-Dimer typically used to diagnose?
a patient with a deep vein thrombosis (DVT) or pulmonary embolism (PE)
67
What is the normal value for a C-Reactive Protein- High Sensitivity (CRP-HS) test?
68
What is C-Reactive Protein
an acute phase reactant and an inflammatory mediator; produced in the liver in response to inflammation and infection
69
When is CRP-HS screening useful?
in assessing likelihood of future cardiac events
70
What does low-density lipoprotein carry?
75% of cholesterol
71
What does high-density lipoprotein carry?
25% of cholesterol; much more protein dense and therefore carries less cholesterol
72
What does a lipid panel generally include?
total cholesterol, triglyceride, HDL, and LDL
73
How often should diabetics have a lipid panel?
annually
74
If initial lipid panel test is normal how often should you test a patient?
test can be performed every 5 years
75
What should be your total cholesterol normal value?
76
What factors increase triglyceride levels?
familial hypertriglyceridemia, hyperlipidemia, hypothyroidism, high carb diet, poorly controlled diabetes, chronic renal failure
77
What factors decrease triglycerides?
malabsorption and malnutrition, hyperthyroidism
78
What factors increase HDL:?
exercise, moderate alcohol use, healthier eating choices, estrogen administration, familial HDL lipoproteinemia
79
What factors decrease HDL?
tobacco use, metabolic syndrome, genetically low HDL, hepatic disease
80
What are lab values for LDL that are ideal for those at risk of heart disease?
70-100 mg/dL
81
What is a high LDL lab value?
>160 mg/ dL
82
How does LDL particle sixe affect risk of CAD?
there is an increased risk of CAD with small, dense LDL particles; these small dense particles are more dangerous and promotes atherosclerosis and thrombosis

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