MARKERS OF INFLAMMATION, HEART FAILURE AND COAGULATION DISORDERS Flashcards by Iseoluwa Ojo

Heart disease

Approximately _______ cases of MI occur annually in the United States.

1.5 million

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Heart disease

Increasing prevalence in Nigeria and Africa

In UBTH – __/______ patients (1998 – 2007 V.A Joseph)

In Aminu Kano Teaching Hospital from 2000 – 2005. Prevalence of CVS diseases –___%

4/1,000

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Symptoms of Heart Disease
There are ——- classic symptoms of heart disease that, if recognized early, can aid in the accurate and early diagnosis of heart disease.

seven

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all individuals with heart disease will experience symptoms

T/F

It is important to note that not all individuals with heart disease will experience symptoms

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all people who experience the 7 seven symptoms will have heart disease.

T/F

not all people who experience symptoms will have heart disease.

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List the 7 classic symptoms of heart disease

Dyspnea
Cyanosis
Chest pain
Palpitations
Syncope
Edema
Fatigue

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Symptoms of Heart Disease

Dyspnea is a medical term used to describe __________

There are three basic types of dyspnea:
________,_________,_________

shortness of breath.

cardiac, pulmonary, and psychological.

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earliest and most common symptom of heart disease is ________, aka ___

shortness of breath

Dyspnea

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Symptoms of Heart Disease

Angina

Angina pectoris, also known as angina, is ______________

It is described as _______ or ______ felt ______ or _____ within the chest.

chest pain from the heart.

griping or crushing central chest pain

around or deep

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_______ is the second most common symptom of heart disease.

Chest pain

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all chest pain is due to heart disease

T/F

However, not all chest pain is due to heart disease as it may originate from other chest structures, a chest muscle or from organs below the chest.

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Angina

The pain may radiate to the ____ or ____ , less commonly to the _____ or ____ , and is associated with pain in _______(usually _____) ______

neck or jaw

back or abdomen

one (usually the left) or both arms.

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Angina is most often caused by _____ (restriction of blood supply to the heart) due most commonly to ______ disease.

ischemia

coronary artery

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Angina is usually worsened by ______ and relieved by ____.

exercise

rest

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Symptoms of Heart Disease

Palpitation is the term used to describe the _____________

awareness one has of their own heartbeat.

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Symptoms of heart disease

Syncope is the term used to indicate _______ or the ________.

fainting or the sudden loss of consciousness

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Syncope may be caused by a number of conditions that result in the _________________________.

deprivation of oxygen and blood to the brain

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The most common cardiovascular cause of syncope is __________(______ ).

Without warning, the patient _______ with a ______________ pulse and, after a ______, recovers.

an irregular heartbeat

arrhythmia

falls to the ground

slow or absent; few seconds

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Symptoms of Heart Disease

Edema refers to the _______ around the ankles, legs, eyes, chest wall, or abdominal wall due to the _____ of ______ or _______ in the cells of the tissues.

swelling of tissue

retention of water or lymph fluid

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The edema associated with heart disease is often present in the morning

T/F

With reason

absent

as fluid is reabsorbed while lying down

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The edema associated with the heart is progressively worse during the day.

T/F

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Symptoms of Heart Disease

Cyanosis is a term used to describe a ________ of the skin and is caused by an increased amount of _________ in the blood due to ______.

bluish discoloration

non oxygenated hemoglobin

dyspnea

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Cyanosis becomes apparent when ___g/dl or more of reduced hemoglobin is present.

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Inflammation and Coagulation Disorders

Markers of inflammation are used for assessment of risk of developing these disorders.

T/F

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Inflammation plays a role in atherogenesis, atherosclerosis, plaque formation and acute coronary syndrome. T/F

The markers of inflammation include ______________(hsCRP), _______________ (PAPP-A) and ________________ (Lp-PLA2).

high sensitivity C-reactive protein pregnancy associated plasma protein A lipoprotein associated phospholipase A2

High-Sensitivity C-Reactive Protein hsCRP is one of the most extensively studied proposed markers of inflammation T/F

______ marker of inflammation Has some controversy regarding its clinical use, but appears to be the most promising to date.

High-Sensitivity C-Reactive Protein hsCRP

High-Sensitivity C-Reactive Protein hsCRP CRP is _______ protein produced by the ____ in response to _____,_____, and _____

an acute-phase ; liver injury, infection, and inflammation.

CRP a (general or specialized?) (specific or nonspecific?) marker of inflammation Has (low or high?) predictive value for coronary artery disease in the healthy population.

General Nonspecific High

Epidemiologic data document a positive association between hsCRP and the prevalence of coronary artery disease. T/F

High-Sensitivity C-Reactive Protein Elevated baseline levels of hsCRP are correlated with higher risk of ______________________ among those with and without clinical evidence of _______

future cardiovascular morbidity and mortality vascular disease.

High-Sensitivity C-Reactive Protein In patients with established vascular disease, each standard deviation increase in baseline hsCRP is associated with a ___% increase in relative risk of _______ or _________ over 2 years of follow-up.

45 nonfatal MI or sudden cardiac death

High-Sensitivity C-Reactive Protein hsCRP only demonstrates prognostic capacity in those who have a diagnosis of vascular disease. T/F

also demonstrates prognostic capacity in those who do not yet have a diagnosis of vascular disease.

High-Sensitivity C-Reactive Protein hsCRP A mild elevation of baseline levels of hsCRP among apparently healthy individuals is associated with __________________________ events.

higher long term risk for future cardiovascular

High-Sensitivity C-Reactive Protein hsCRP It’s predictive capacity offers patients the ability to receive treatment to reduce _____ and, thus, their risk.

inflammation

Pregnancy-Associated Plasma Protein A PAPP-A is a ____-binding protein found in high serum concentrations of women in ( early or advanced?) stages of pregnancy.

zinc Advanced

Pregnancy-Associated Plasma Protein A PAPP-A was recently identified as a major contributor to the progression of ________ by _______et al., who found high levels of PAPP-A in the cells and extracellular matrix of _____ from patients who died suddenly of cardiac causes.

atherosclerosis Bayes-Genis ; plaques

Pregnancy-Associated Plasma Protein A PAPP-A These researchers also found high concentrations of PAPP-A in (stable or unstable?) plaques compared with (stable or unstable ?) plaques.

Unstable Stable

Lipoprotein-Associated Phospholipase A2 LP-PLA2, also known as ______ factor ________, is an enzyme associated with the (small or large?) , (light or dense?) LDL cholesterol particles, which are pathogenic and readily undergo ____ modification.

platelet-activating; acetyl hydrolase Small; dense; oxidative

Lipoprotein-Associated Phospholipase A2 circulates mainly bound to _____ and ___, and studies have shown that elevated LP-PLA2 values are associated with an increased risk for _____ and _____

LDL and HDL heart disease and stroke.

Lipoprotein-Associated Phospholipase A2 When analysed with ____, it was shown to have an ____ effect of increasing risk for CVD.

CRP additive

INFLAMMATION AND CARDIOVASCULAR DISEASE Atherosclerosis Deposition of ______ in the _____ of blood vessels which protrude into and obstruct vascular lumens and weaken the vessels.

fibrofatty plaques intima

pathogenesis of atherosclerosis STAGE 1 ______ formation. These are the earliest lesions of atherosclerosis. It is initiated by focal increases of ____ containing ____ in the ___ of the vessels.

Fatty steak; apo B ; lipoproteins; intima

pathogenesis of atherosclerosis • Fatty steak formation. The vascular endothelium induces cytokine release to the presence of the chemically modified lipoprotein particles within the intima of the blood vessels. The cytokines; ________ and ______, mediate ________________ to the site of the lesion. These cytokines also regulate the expression of ________ leading to further leukocyte recruitment.

interleukins 6 and tumour necrosis factor-alpha mononuclear leukocyte migration adhesion molecules

pathogenesis of atherosclerosis Stage2 _______ formation In the intima, the mononuclear phagocytes differentiate into ______ that take up the ________ particles by endocytosis and transform into _____ laden _____ cells

Foam cell macrophages modified lipoprotein lipid laden foam cells.

pathogenesis of atherosclerosis Foam cell formation The foam cells further elaborate _______ and _______ that contribute to plaque evolution.

cytokines and growth factors

pathogenesis of atherosclerosis Stage 3 ______ evolution Inflammatory cytokines secreted by the modified macrophages;____ and ____ and _______ from activated T-lymphocytes, contribute to atherogenesis.

Atheroma IL-1, TNF- alpha; interferon-gamma

pathogenesis of atherosclerosis Atheroma evolution The evolution of the fatty streak to the complex fibrofatty atherosclerotic lesion is as a result of _______ recruited into the ______ from the ____ of the blood vessel by products of the _________

smooth muscle cells intima Media; modified macrophages.

pathogenesis of atherosclerosis Atheroma evolution The smooth muscle cells elaborate ______ which contribute to the growth of the atheroma.

extracellular matrix

Testing the Inflammatory Hypothesis of Atherosclerosis Inflammation plays a major role in heart attack and stroke, and patients with elevated inflammatory biomarkers such as high sensitivity C- reactive protein (hsCRP) have increased vascular risk. Yet, it remains unknown whether ________ will reduce the risk of recurrent heart attack and stroke for our patients.

direct inhibition of inflammation

Markers of Congestive Heart Failure The natriuretic peptides (NPs) are a group of hormones that include _________ (ANP), ______ (BNP), _________ (CNP), and ________ (DNP).

atrial natriuretic peptide B-type natriuretic peptide C-type natriuretic peptide D-type natriuretic peptide

The Natriuretic peptides play an important role in the regulation of cardiovascular homeostasis. T/F

__NP and the ______ fragment of its prohormone (______) are released on _____ stretch or stress to the myocytes in the (presence or absence?) of necrosis.

B terminal ; NT-proBNP ventricular Absence

Markers of Congestive Heart Failure Therefore, BNP is _____eased in diseases characterized by an expanded fluid volume (e.g., renal failure, hepatic cirrhosis, primary aldosteronism, and congestive heart failure) These conditions are characterized by (enhanced or reduced?) renal clearance of peptides or stimulation of peptide production.

Incr Reduced

BNP and not NT-proBNP work well in diagnosing heart failure

F Both BNP and NT-proBNP

BNP and NT-proBNP are of prognostic value in patients with acute coronary syndromes. T/F

Markers of Congestive Heart Failure BNP has a circulating half-life of _______, so it is indicative of a ______ of myocardial function, while NT-proBNP circulates approximately ______, giving a (shorter or longer?) view of myocyte function.

20 minutes; snapshot; 1.5 hours Longer

Role of Laboratory in Monitoring Heart Disease The laboratory’s role in monitoring heart function primarily involves measuring the _________ on ________ such as the lungs, liver, and kidney.

effects of the heart on other organs,

Arterial blood gases measure the patient’s _______ and _____ status and are used to determine the respiratory (acidosis or alkalosis?) and elevated ________ levels that are often seen in patients with heart disease

acid-base and oxygen acidosis carbon dioxide

Role of Laboratory in Monitoring Heart Disease Decreased cardiac output results in sodium ________ by the kidneys but also causes increased fluid ______ therefore, the serum sodium level generally ____________ or may be _________.

retention retention remains within the reference ranges slightly decreased

Serum electrolyte determinations, including _____,_____,_____ and ______ are important to monitor diuretic and drug therapy in patients with heart disease.

sodium, potassium, chloride, and calcium

Role of Laboratory in Monitoring Heart Disease Elevations of ____,_______, and _____ are often seen in patients with chronic right ventricular failure, and the - ________value may be twice the value of the upper limit of the normal range in CHF, suggesting ______ congestion and damage.

AST, alanine aminotransferase (ALT), and alkaline phosphatase (ALP) glutamyltransferase (GGT) liver

Role of Laboratory in Monitoring Heart Disease Lipid evaluation will assess risk for _______ disease. Maintenance of near-normal ________,________, and _______ levels is highly recommended for cardiac patients.

coronary artery HDL cholesterol, LDL cholesterol, and triglyceride

AST is found in the _____ of the liver ALT is found in the ______ of the liver

Mitochondria Cytosol

Alcohol affects the _____ of the liver Viral hepatitis affects the ______ of the liver

Mitochondria Cytosol

________ ACP is the most tartarate labile

Prostatic

Ig__ is the gamma globulin that can cross the placental barrier

Cancer of the _____ can cause obstructive jaundice

Head of pancreas

Which type of diabetes mellitus, is there weight loss

Type1

Classical symptoms of tipe 1 DM is ??

Polyuria Polydispsia Polyphagia

Clotting factors test can be used to test the functioning of the liver T/F

Types of headaches ________ _______ __________

Tension Cluster Migraines

Clinical features of stroke ______ speech ________ _________ eyelids _____ levels on __________ scale (less than ____)

Slurred Paralysis Drooping Low; Glasgow coma; 3

Spironolactone causes _______ and _______ Side effects of methyl dopa is _______ Loop diuretic causes _____

Hyperkalemia and gynecomastia Hemolytic Anaemia Ototoxicity

CNP is produced in the ??

Ventricle

_______ is the commonest cause of heart disease _______ is the commonest cause of heart failure

Dyspnoea Edema