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Biochemistry And Endocrinology > Biochemical Markers of Cardiac Damage and Function > Flashcards

Biochemical Markers of Cardiac Damage and Function Flashcards

1
Q

what is ischaemic heart disease?

A

lack of oxygen to mucles leading to pain and damage - can cause heart attack

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2
Q

What is heart failure?

A

Impaired muscle function- blood is pulling in the wrong places

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3
Q

What causes acute myocardial infraction?

A

Loss of blood supply and oxygen due to atherolsceloris which causes cell death

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4
Q

What is primary prevention?

A

Trying to prevent a healthy individual who is at risk of a heart attack from having one

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5
Q

What is secoary prevetn?

A

Trying to prevent someone who has already had a heart attack from having another one.

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6
Q

What does biochemical markers aim to do?

A

identify indivduals most likely to benefit from preventative treatments “primary prevention”

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7
Q

What do we use to see if someone should be put on preventative medication? What info is needed and what percentage do you get put on medication?

A

Assign - Postcode, LDL, total cholesterol, high BP, diabetes, family history, inflammatory conditions, smoker statis.

Any one with a risk score of over 20% gets put on meds.

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8
Q

What are the specific biochemical markers which are used to assess peoples risk of having a heart attack?

A

Increased Total cholesteral
Increased LDL

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9
Q

How can risk stratification be improved?

A
  • Add aditional biochemical markers
    • Other atherogenic lipoproteins
    • Troponin
    • CRP
  • Reduce cost
  • lack of familiraty with doctors
  • Improve risk score calculations - use AI or use the same as England does.
  • Imaging
  • improve communication with patients
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10
Q

Do people with high CRP have more heart attack risk than people with low CRP?

A

Yes

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11
Q

How to diagnose MI? You need two out of three of the following?

A

History - severe chest pain
Characteristic ECG
Markers in blood of cardiac muscle injury

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12
Q

What are characteristics of an ideal bio marker?

A

High tissue concentration
Released quickly into circulation in response to tissue damage
Tissue specific
Moderate half life
Stable
Useful in diagnosis and monitoring

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13
Q

What are the Older markers of MI?

A

AST
LDH
CK Activity
CK-MB

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14
Q

What was wrong with the older markers of MI?

A

They were not cardiac specific and slow to rise

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15
Q

What is troponin?

A

Component of thin filaments in striated muscle complexed to actin which regulates muscle contraction.

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16
Q

What are the 3 subunits of troponin?

A

Troponin T
Troponin I - used most commonly as a bio marker
Troponin C

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17
Q

How do we measure troponin?

A

Immunoassays with monoclonal antibodies

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18
Q

Features of troponin which makes it a good bio marker?

A

Tissue specific,
Very sensitive,
Useful for early and late presentations,
Predicts future cardiac events

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19
Q

Roughly how big would the heart damage need to be to sense troponin?

A

Tiny

20
Q

When would you diagnose a MI?

A

When troponin is bigger than the 99th percentile of a reference population,

21
Q

Is troponin gender specific?

A

Yes

22
Q

Does a lower diagnostic threshold improve patient outcomes?

A

Yes - you know about heart attacks before it started e.g. people who had slightly raised troponin previously wouldn’t have been given medication and they where the most likely group to have further MI’s or die because they weren’t viewed as having a heart attack

23
Q

Why is it important that there is gendered values of troponin?

A

Women are more likely to die from heart attacks as their levels of troponin when having a heart attack are the levels of healthy men - so people would just assume they were healthy.

24
Q

What else can raise troponin?

A

Heart issues - severe arrhythmias, cardiac inflammation, aortic dissection
Myocardial injury
Respiratory - acute pulmonary embolus
Sepsis
Severe GI bleed
Renal - chronic kidney disease
Endocrine - severe hyperthyroidism
Artificial - assay related
Endurance excessive , inherited disorders (Duchenne muscukodystrophy, rhabdomyolysis)

25
Q

If there is doubt in troponin levels and cause what do you do?

A

Give another test in 12 hours and troponin should keep rising

26
Q

How do you treat MI?

A

Aspirin, angioplasty, stents etc.

27
Q

The higher troponin level what are you at increased risk of?

A

Another MI and death due to the high level of damage in the heart.

28
Q

What are the symptoms of heart failure?

A

Breathlessness, ankle swelling, fatigue and signs (increased JVP, lung creps, peripheral oedema)

29
Q

What causes heart failure?

A

Structural and or functional abnormalities leading to increased pressure and or not enough cardiac output at rest or exercise

30
Q

Why is diagnosing heart failure important?

A

It’s common, and mortality in the next 5 years is common
It’s expensive
Diagnosis is inaccurate

31
Q

What drugs would you give to someone having heart failure?

A

ACE inhibitors, beta blockers, entresto, SGLT2 inhibitors

32
Q

How do you diagnose heart failure?

A

Image heart and look at blood flow - echocardiography, MRI
Biochemical tests - natriuretic peptides

33
Q

Natriuretic peptides - where do ANP and BNP come from?

A

Myocytes releases ANP and BNP when pressure and vasoconstriction takes place.

34
Q

Natriuretic peptides - what does BNP (b type natriuretic peptide) and ANP (A type natriuretic peptide) cause?

A

These cause vasodilation and increases the amount of salt and fluid you excrete from the body.

35
Q

What do we measure in the lab to assess heart failure? And how is this made?

A

Mainly BNP which is first produced as preproBNP before being cleaved into ProBNP and then nt-proBNP before BNP. You can measure both nt-proBNP and BNP

36
Q

What is more stable in the blood - nt-pro BNP or BNP?

A

Nt-pro BNP

37
Q

When would you test for BNP?

A

Suspect heart failure,
Breathlessness
After an MI

38
Q

Is BNP sensitive?

A

Yes

39
Q

Is BNP specific?

A

No - increase with age and hypertension, MI, atrial fibrillation, valvular heart disease, severe COPD, pneumonia, pulmonary embolism, sepsis, cirrhosis

40
Q

Is BNP good as a rule out test?

A

Yes if they don’t have BNP they don’t have heart failure

41
Q

Do you test BNP, ECG and CXR before imagining or after to confirm heart failure?

A

Before

42
Q

What is point of care cardiac bio markers?

A

A test in an a and e department or ambulance

43
Q

Why are point of care cardiac bio markers good?

A

More immediate results

44
Q

Why might point of care cardiac bio markers not be ideal?

A
  • Not as sensitive,
  • Results might not be comparable with main lab - especially is an immunoassay is needed - some people might need serial blood tests down to see is troponin is rising
  • Quality assurance harder to achieve outside of main lab
  • Interfacing results with patient record
  • Cost
45
Q

What do you test if someone is having chest pain?

A

Troponin

46
Q

What do you test is someone is breathless?

A

BNP, D-dimer

Biochemistry And Endocrinology (16 decks)

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