Cardiac Flashcards
what is c reactive protein (CRP)
non specific marker of inflammation
non specific on its own
what is high sensitivity CRP (hs-CRP)
independently predicts adverse cardiac events
also shown to be independent predictor of cardiac death, AMI, CHF
elevated this or CRP would elevate lipid panel
if elevated CRP and hs-CRP + elevated lipid panel
7x increase risk of heart attack or stroke
synergistically bad
independenlty increase risk, but together increase alot
what is myeloperoxidase
linked to plaque instability, plaque creation, and vasoconstriction from NO depletion
independently predicted increased risk for major cardiac events in those presenting to the ED with chest pain
aka measures plaque instability - indireclty tells you cardiac risk
what is the most sensitive and specific cardiac biomarker for MI?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
troponin I
what is troponin I
contractile proteins of myocardium
released only when myocardial necrosis occurs
the only cardiac biomarker recommended in evaluating pts with acute MI
with acute MI what are the levels of troponin
serum levels rise within 3-12 hours of onset
peak at 24-48 hours
remain eleavted for 14 days!!!
aka a linear relationship between incresing conc of biochem markers and the short term mortality in acute MI
what is hs-cTn
high sensitivity cardiac troponin
subset of troponin test
helpful if obtained within 4 hours of MI symptoms
good for ruling out MI
but troponin I took over
could have utility in primary prevention of CV disease in high risk populations with silent heart disease
what is CPK
what elevates
creatine phosphokinase (CPK)
cardiac biomarker - focused on the ck–MB (cardiac) also ones for brain and skeletal muscle
can be elevated after exercise
- just like normal creatinine can be elevated with muscle breakdown
statins also elevate
myalgia
what is CK-MB
creatine kinas - MB- cardiac
was the best for MI before troponin I
best benefti now in considering Reinfarction !!!
because levels rise again after initally declining following MI
why is myoglobin measured
had benefit as early marker for AMI
non cardiac specificity is a problem
EARLIEST MARKER EVALUATION
-can elevate in 2-4 hours whil still waiting on troponin and ck-MB to elevate
can be earliest sign
only 50% specific - aka not great - not as useful with troponin use
testing strategy for acute MI
use a single negative CK-MB, Tnl 8-12 hours after onset
aka if troponin and ck-mb negative after 8 hours= send home
what is b-type natriuretic peptide cardiac biomaker
b type natriuretic peptide used to evaluate CHF
-released by ventricular myocardium in response to wall stress and volume expanison
may indicate with a higher level of this= more severe
CHF
“A B test will tell you C! (CHF)
what has shown to reveal a doubled mortality rate in those acute MI patients with elevations in what
BNP and Tnl
the higher the level of BNP, the …
more severe the CHF
very helpful in evaluating SOB
- if the BNP is elevated, likely respiratory in natrue!!!!!!!!!!!!!!!!!!!!
