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Clinical Chemistry 1 > 12. Cardiovascular Assessment > Flashcards

12. Cardiovascular Assessment Flashcards

1
Q

What are the 4 major types of cardiovascular disease?

A
  1. Coronary Heart Disease (CHD)
  2. Cerebrovascular disease
  3. Peripheral arterial disease
  4. Aortic atherosclerotic disease
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2
Q

What is coronary heart disease (CHD)? What is the main cause? How is myocardial infraction (MI) related to CHD?

A

Coronary heart disease is a narrowing of the small blood vessels that supply blood and oxygen to the heart. Coronary heart disease (CHD) is also called coronary artery disease. Coronary artery disease mainly caused by atherosclerosis. Atherosclerosis is the buildup of plaque inside your arteries.

A myocardial infarction (commonly called a heart attack) is an extremely dangerous condition caused by a lack of blood flow to your heart muscle, causing death of heart muscle cells (permanent damage). CHD can cause MI

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3
Q

What is cerebrovascular disease? How is it related to stroke and ischemia?

A

Cerebrovascular disease refers to a group of conditions that affect blood flow and the blood vessels in the brain.

Lack of sufficient blood flow (also referred to as ischemia) affects brain tissue and may cause a stroke. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot (ischemic stroke) or bursts/ruptures (hemorrhagic stroke)

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4
Q

What is peripheral artery disease (PAD)? What is the main cause?

A

Peripheral arterial disease (PAD) in the legs or lower extremities is the narrowing or blockage of the vessels that carry blood from the heart to the legs. It is primarily caused by the buildup of fatty plaque in the arteries, which is called atherosclerosis.

Acute localized pain in arms and legs (more often legs)

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5
Q

What is aortic atherosclerotic disease? How is it related to aneurysms and dissections?

A

Aorta (largest artery) with atherosclerotic plaque, nutrients can no longer seep through sufficiently. The cells receive no oxygen, and some of them die. As the atherosclerosis progresses and cells continue to die, the walls become weaker and weaker. Hardening and narrowing of blood vessel.

Aortic atherosclerotic disease can cause aneurysm. Aneurysm means you have a bulge in the weakened wall of an artery. It can rupture if at severe stage. Having an aortic aneurysm increases the risk of a tear in the aortic lining (aortic dissection), as shown in the image. This can compromise blood flow in the main portion of the vessel and result in loss of blood flow to critical organs. Dissections can also occur in any vessel

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6
Q

What is myocardial ischemia?

A

Ischemia: an inadequate blood supply to an organ or part of the body, especially the heart muscles (myocardial ischemia)

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7
Q

What is the difference between stable and unstable angina?

A

Angina is chest pain or discomfort you feel when there is not enough blood flow to your heart muscle.

Stable angina is the most common type. It happens when the heart is working harder than usual, usually by physical activity. Can be due to emotional stress, heavy meals, cold temperstures. Stable angina has a regular pattern.

Unstable angina is the most dangerous. It does not follow a pattern and can happen without physical exertion. Caused by blood clot or fatty deposits in arteries tears and forms blood clot. Unstable angina worsens and isn’t relieved by rest or your usual medications. If the blood flow doesn’t improve, your heart is starved of oxygen and a heart attack occurs. Unstable angina is dangerous and requires emergency treatment.

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8
Q

What are the signs of acute coronary syndrome/myocardial infarction (3)?

A
  1. Chest pain/pressure/burning
  2. Difficulty breathing
  3. Left arm pain
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9
Q

What is the defintion of infarction and what does it result in?

A

Blood flow stops completely and causes cell death (necrosis)

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10
Q

What is congestive heart failure?

A

Condition in which the heart doesn’t pump blood as well as it should. Heart failure can occur if the heart cannot pump (systolic) or fill (diastolic) adequately.

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11
Q

Congestive heart failure can be due to severe or repeated __________

A

Myocardial infarctions (MI)

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12
Q

Development of ___________ can predispose blood vessels to thrombosis, which can cause _________ __________ and __________.

A

Development of atherosclerosis can predispose blood vessels to thrombosis, which can cause organ ischemia and infarction.

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13
Q

Atherosclerosis can be due to (4):

A
  1. Chronic inflammation
  2. Injury to blood vessel wall
  3. Hyperlipidemia
  4. Hyperhomocysteinemia (increased oxidant stress, impaired endothelial function, and induction of thrombosis)
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14
Q

What are risk factors for atherosclerosis (7):

A
  1. Smoking
  2. Cholesterol
  3. Hypertension
  4. Diet
  5. Physical Activity
  6. Family History
  7. Gender
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15
Q

What does the initial lab workup consist of (5)?

A
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16
Q

What is the preferred marker for MI detection?

A

Cardiac troponins I and T (cTnI, cTnT)

(Skeletal muscle also has troponin I and T

17
Q

On the troponin complex, what is the difference between troponin I (cTnI) and troponin T (cTnT)?

A

Troponin I - inhibitory: prevents myosin from binding to actin in relaxed muscle.

Troponin T - tropomyosin binding: binds to tropomyosin to help it move

(Troponin C - calcium binding)

18
Q

Why is troponin I and T used as markers and not troponin C?

A

Troponin I and T leak with tissue necrosis

19
Q

Troponin T can be measured ____ hours after MI

A

6 hours

20
Q

What method is used to measure troponin T?

A

Measured with immunoassay method, antigen antibody complex linked to dye, enzyme or chemiluminescent agent

21
Q

What is the reference range of Troponin T?

A

Reference range < 0.01 ug/L

22
Q

What method is used to measure Troponin I?

A

Tested by immunoassay method with monoclonal antibody to cTnI. Chemiluminescence reaction binds the cTnI to monoclonal antibody attached to test tube. Second monoclonal antibody with acridinium derivative conjugate sandwiches the troponin (Sandwich ELISA). Chemilunescence quanitified.

23
Q

What is the reference range for Troponin I?

A

Reference range: below or equal to 0.05 ng/mL

24
Q

Which creatinine kinase marker is specific for cardiac muscle (CK-MM, CK-MB, CK-BB)?

A

CK-MB

25
Q

CK-MB is detected ___ to ___ hours after onset.

A

CK-MB detected 6-18 hours after onset (short detection window due to protein degradation)

26
Q

What is the function myoglobin? Where is it located?

A

Present in the heart and skeletal muscle, function as reservoir of O2 and CO2 carrier in muscle.

27
Q

Which is the first marker that increases in MI, and when does it increases (# hours)?

A

Myoglobin, increases within 2 hours post-MI

28
Q

Why does myoglobin return to normal levels within the first 24 hours after onset of symptoms? (reason why it is a less commonly used marker)

A

Myoglobin is rapidly cleared from the serum into the urine

29
Q

How is evaluating C-reactive protein useful in assessing atherosclerosis?

A

C-reactive protein (CRP) is acute phase protein (increase significantly during acute phase of an imflammatory process)

C-reactive protein (CRP) produced by body when blood vessel walls are inflamed. Higher CRP levels, the higher severity of inflammation (more plaque)

30
Q

C-reactive protein (CRP) is released after ___________ ___________, and correspond with elevated _______

A

CRP is released after myocardial infarction, and correspond with elevated CK-MB.

31
Q

Beta natriuretic peptide (BNP) or BNP precursor (NT-proBNP) is elevated when?

A

Both BNP and NT-proBNP are released in response to changes in pressure inside the heart. These changes can be related to heart failure and other cardiac problems (ventricular dysfunction). Rises when condition worsens

32
Q

Which markers are currently used to diagnose acute coronary syndrome (ACS)/acute myocardial infarction (AMI)?

A

CK-MB, cTnI, cTnT, hsTn (high sensitivity cardiac troponin)

33
Q

Which markers are used for cardiovascular risk stratification?

A

cTnT, cTnI, hsCRP, homocysteine

34
Q

Which markers are used to differentiate heart failure from lung disease?

A

BNP and NT-proBNP

35
Q

Which markers are used to diagnose pulmonary embolism/risk stratification

A

BNP, NT-proBNP, D-Dimer, cTnI, cTnT

36
Q

Which markers are no longer used/used less commonly/experimental?

A

LD (lactate dehydrogenase - not specific enough), myoglobin, hsTn

37
Q

Elevated homocysteine levels results in?

A

atherosclerosis

Clinical Chemistry 1 (6 decks)

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