Biomarkers for Cardiac Disease Flashcards
Risk Factors (RFs) for CHD (10)
-Age
-FMHx of CVD
-Male
-Unctrlled HTN & DM
-Incr. cholesterol (low HDL, high LDL, high triglycerides)
-Smoking, alcohol
-Sedimentary, poor diet
-Overweight/Obese (BMI = 25-30, 30-40, or >40)
-Postmenopausal
-Unctrlled stress
LDL levels for incr. risk of CVD
> 50mg/dl
What is cholesterol and what are the normal and abnormal levels of it in the blood?
-Waxy, fat-like substance thats a component of cell walls/fluidity and a precursor molecule for Vit D & sex steroids
Norm = <200 mg/dL
Borderline High = 200-239 mg/dL
High = > 240 mg/dL
What is the carrier molecule that is required for effective transport of cholesterol in the blood? What are the different types?
-Lipoprotein
-Type based on density:
-HDL = High Density Lipoprotein
-LDL = Low Density Lipoprotein
-VLDL = Very Low Density Lipoprotein
Lipid Panel Includes: (4)
1) Total cholesterol (HDL + LDL + Triglyceride)
2) LDL (Total - HDL - Trigly / 5)
3) HDL
4) Triglycerides
Type of lipoprotein that’s inversely associated w/ Coronary Heart Disease.
Levels also increase with exercise.
HDL
Lipoprotein that’s a causal RF for MI and atherosclerotic CVD.
LDL
MOI of LDLs
LDLs invade tunica interna of vessels & form an atheroma (accumulation of materials in layer of artery wall). WBCs/macrophages move to area creating inflammatory rxn. Fibrous conn. tissues collects & swelling create an atherosclerotic plaque.
Lipoprotein that’s estimated as a & of triglyceride value, but not a part of a lipid panel. High levels assoc. w/ plaque on artery walls.
VLDL
What is Lipoprotein A & what are high levels assoc. w/?
-Lipoprotein subclass w/ an atherogenic & prothrombotic effect
-Atherosclerosis
Lipoprotein A is a RF for:
CAD, CHD, CVA, thrombosis
What is triglycerides & what are high levels assoc. w/?
-Glycerol molecule + 3 fatty acids
-Atherosclerosis, heart disease (HD), & CVA
T/F: Cholesterol Ratio are clinically more important than Total cholesterol number.
False
Cholesterol Ratio
-200/50 mg/dL = 4:1 ratio of Total cholesterol to HDL
-The lower, the better.
-Ratio should be kept to 5 or less.
Types of triglycerides
saturated and unsaturated fats
What is saturated fats and high levels assoc. w/?
-fat molecules w/ no double bonds b/c they are saturated w/ hydrogen molecules
-high levels assoc. w/ HD & CVA
What is unsaturated fats and some types?
-Fat w/ =/>1 double bonds w/ a low melting point (room temp). Can be mono- or poly- unsaturated.
-Trans and Cis fatty acids
What are Trans Fatty Acids and high levels assoc. w/?
-Produced in veggie oils/fats, uncommon in nature
-High levels assoc. w/ Coronary Vascular Disease
T/F: Cis Fatty Acids are naturally occurring and good for your health.
True
Triglyceride Levels
Norm = <150
Borderline High = 150-199
High = 200-499
Very High = >500
Men and women at incr. risk of CHD should get cholesterol screening as early as what age?
20 y/o
All men and women should get cholesterol screening at what ages? and How often?
Men > 35 y/o
Women > 45 y/o
Children should have their cholesterol check b/w ages ______ and again b/w ages ___.
9-11 y/o
17-21 y/o
Medications used to manage Lipid levels (3)
1) Statins
2) Niacin (Vit B3)
3) PCSK9 inhibitors (new drug class, reduce degradation of LDL, lowering LDL blood levels)
Statin Induced Myelopathy and RFs for this
-Myalgias to muscle tenderness, to weakness to rhabdomyolysis (leads to kidney failure)
-Usually resolve after stopping meds
-RFs: high dose, incr. age, mult. diseases, frail, immunosuppressant drugs
Pathophysiology of CVD & DM (Diabetic Heart Disease)
-Hyperglycemia creates a proinflammatory statre which incr. platelet activation (CVA/ischemia risk) & dyslipidemia tht drives arterial stiffness (atherogenesis)
Structural abnormalities characteristic of a diabetic heart. (5)
-Fibrosis
-Cardiac hypertrophy
-Impaired Coronary Microvascular Perfusion
-Mitochondria dysfunction
-Impaired calcium handling
“Cardiac Enzymes”
blood values of biomarkers that incr. w/ the occurrence of an MI
Ischemic insult can lead to…
cell injury/death → sarcolemma disruption → movement of contents into IS & blood.
What is Creatine Phosphokinase and its diff forms (3)?
-Catalyzes conversion of creatine & ATP to phosphocreatine (PCr) and ADP. PCr is an immediate energy source.
-Forms:
-**MB: most specific, Myocardial Band injury
-MM: MSK damage
-BB: for brain tissue injury
CPK serum levels after MI or other injury/insult
Rise: 4-6 hrs
Peak: 12-24 hrs
Remain elevated: 4-5 days
Norm levels: </=175
T/F: HBDH & LDH rise 6 hrs following MI, but AST & CPK levels elevate must later & remain high for a longer period.
False, its flip flopped
Troponin & diff forms/types (3)
Group of proteins in striated muscle that bound to actin. Released/levels rise after cardiac muscle injury.
-TnC = binds to Ca
-TnI = inhibits actin/myosin interaction
-TnT = links troponin to tropmyosin
Normal Levels of Troponin and levels after MI
Norm =/< 3.0
Rise: 4-6 hrs (TnI) 3-4 hrs (TnT)
Peak: 12-24 hrs (TnI) 10-24 hrs (TnT)
Remains elevated: 4-7 days (TnI) 10-14 days (TnT)
T/F: Myoglobin levels rise faster than Troponin and began to drop rapidly within a day after an MI.
True
What is myoglobin and normal serum levels?
-Heme protein in all muscle tissue (stores O2).
Potential dx tool for acute MI
Norm = 25-72
When can you detect myoglobin after an MI and what would blood levels look like?
-As early as 2 hours after injury
-Peak: 3-15 hrs after injury
Why is a liver panel of interest post-MI
CO dysfunction leads to reduced liver perfusion leading to congestion of blood in the liver & incr. component in liver panel
Patients with HF have (elevated/depressed) serum levels of bilirubin.
Elevated
What is ANP and what does it result in?
-Hormone secreted in response to atrial distention
-Inr. GFR & limits RAAS activation
-Results in vasodilation, diuresis, ↓ preload, ↓ afterload, ↓ heart workload
What serum level is a marker for severity of HF?
ANP increases with increasing HF severity (inhibits cardiac hypertrophy & fibrosis)
What is the gold standard for measurement of compensated & uncompensated HF?
BNP
What is BNP and levels in pts with HF
-Produced in response to ventricular distention (incr. LVEDV caused by decr. GFR, cardiac muscles being stretched)
-limits RAAS activation too
-BNP increases with increasing HF severity too
BNP Normal Levels and Levels in pts w/ HF
Norm = <100
Chronic cardiac compensation = 100-700
Acute cardiac decompensation = >700
Classifications of Cardiac disease
1) disease but no S&S or limitations
2) mild S&S & slight limitations
3) marked limitation d/t S&S, only comfortable at rest
4) severe limitations w/ S&S at rest, bedbound
What is C Reactive Protein (CRP) and what are norm levels
-Produced/secreted from liver in inflammatory states (atherosclerosis, CHF, cancer, infection, liver dysfunction)
-Measure of inflammation levels in body
Norm = <1
High risk = 1-3
Evaluated for non-CV diseases (autoimmune, cancer, infection) = >10
T/F: Among postmenopausal women, whether CRP levels are high or low, if cholesterol ratio is high then risk of CV event increases.
true
What is serum creatinine and norm levels/levels that predict CV mortality?
-Blood levels reflect kidney function (decr. function = decr. renal perfusion)
Norm = <1.5
CV Mortality Predictor = incr. levels of serum creatinine
